Early clozapine discontinuation: who is at risk?

Clozapine is almost always the drug of last resort, so when clozapine is initiated no alternatives with proven efficacy remain. However the discontinuation rate of clozapine treatment is disturbingly high, ranging between 18 and 57%. Discontinuation can be a result of serious adverse events, aversion of the necessary, frequent blood tests or a lack of effect. Considering the high frequency of clozapine discontinuation and the numerous reasons for drug cessation, knowing which patients are at risk for discontinuing clozapine, has important implications. It could help the physician to select patients, eligible for clozapine treatment, who need extra care to prevent early, unwarranted discontinuation. Therefore we aim to develop a multivariate predictive model for clozapine discontinuation after twelve months of therapy in a large, both in and outpatient with psychotic disorders in the Netherlands.

Several reasons for clozapine discontinuation are known, but the current evidence identifying patients who are at risk of discontinuation of clozapine is small and not always consistent. Also cultural differences may question if international results are generalizable to other countries worldwide. The available evidence of prediction of clozapine discontinuation is based on relatively small, mainly inpatient populations with follow-up periods ranging from 19 months until 15 years, conducted in the United States and Israel. Therefore, the need for a multivariate predictive model for early discontinuation of clozapine in a large, both in and outpatient population in the Netherlands, still remains.
We aim to develop a multivariate predictive model for clozapine discontinuation after twelve months of therapy in a patient population with psychotic disorders.

6 months and 12 months after start of clozapine

not applicable (predictive modelling study)