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Continuation of clozapine treatment: practice makes perfect

Department of Pharmacy, South London and Maudsley Trust, London

TIL WYKES

Department of Psychology, Institute of Psychiatry, King's College London, De Crespigny Park, PO Box 77, London SE5 8AF

DENISE DUNCAN-McCONNELL

Department of Pharmacy, South London and Maudsley Trust, London

ELKE HAWORTH

Department of Psychology, Institute of Psychiatry, London

NICK WALSH

Section of Neuroimaging, Institute of Psychiatry, London

SARAH HASTILOW

Department of Psychology, Institute of Psychiatry, London

Declaration of interest

E.W. has received lecture fees from Eli Lilly and Zanofisynolab, D.D.-M. has received funds from Eli Lilly and AstraZeneca, T.W. has received unrelated and unrestricted charitable grants and lecture fees from Novartis, AstraZeneca and Janssen Pharmaceuticals, N.W. is now supported by an unrelated grant from GlaxoSmithKline.

AIMS AND METHOD

The study aimed to identify the predictors of drop-out from clozapine treatment by examining the demographic and clinical characteristics of patients registered on clozapine within a 6-month period in one NHS Trust.

RESULTS

During the study period, 54 patients were registered and began clozapine treatment and 31% had discontinued within 6 months. Two people died and the remainder discontinued because of non-compliance or side-effects, including neutropenia. Two factors were predictive: the age of the patient (older patients were more likely to discontinue) and the hospital where the initial registration was made.

CLINICAL IMPLICATIONS

Neither ethnicity, previous registration nor the individual prescriber are a bar to successful persistence with clozapine. However, one set of hospitals with a history of evidence-based practice and high clozapine prescribing was more successful in retaining patients on maintenance treatment. Although specific dataare needed to identify more subtle contributing factors to continuation, it is clear that there is scope for improving the rate of persistence with clozapine treatment.