Clozapine as a first- or second-line treatment in schizophrenia: a systematic review and meta-analysis. 2018

C Okhuijsen-Pfeifer, and E A H Huijsman, and A Hasan, and I E C Sommer, and S Leucht, and R S Kahn, and J J Luykx
Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

No consensus exists on whether clozapine should be prescribed in early stages of psychosis. This systematic review and meta-analysis therefore focus on the use of clozapine as first-line or second-line treatment in non-treatment-resistant patients. Articles were eligible if they investigated clozapine compared to another antipsychotic as a first- or second-line treatment in non-treatment-resistant schizophrenia spectrum disorders (SCZ) patients and provided data on treatment response. We performed random-effects meta-analyses. Fifteen articles were eligible for the systematic review (N = 314 subjects on clozapine and N = 800 on other antipsychotics). Our meta-analysis comparing clozapine to a miscellaneous group of antipsychotics revealed a significant benefit of clozapine (Hedges' g = 0.220, P = 0.026, 95% CI = 0.026-0.414), with no evidence of heterogeneity. In addition, a sensitivity analysis revealed a significant benefit of clozapine over risperidone (Hedges' g = 0.274, P = 0.030, 95% CI = 0.027-0.521). The few eligible trials on this topic suggest that clozapine may be more effective than other antipsychotics when used as first- or second-line treatment. Only large clinical trials may comprehensively probe disease stage-dependent superiority of clozapine and investigate overall tolerability.

UI MeSH Term Description Entries
D003024 Clozapine A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with administration of this agent. Clozaril,Leponex
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012559 Schizophrenia A severe emotional disorder of psychotic depth characteristically marked by a retreat from reality with delusion formation, HALLUCINATIONS, emotional disharmony, and regressive behavior. Dementia Praecox,Schizophrenic Disorders,Disorder, Schizophrenic,Disorders, Schizophrenic,Schizophrenias,Schizophrenic Disorder
D014150 Antipsychotic Agents Agents that control agitated psychotic behavior, alleviate acute psychotic states, reduce psychotic symptoms, and exert a quieting effect. They are used in SCHIZOPHRENIA; senile dementia; transient psychosis following surgery; or MYOCARDIAL INFARCTION; etc. These drugs are often referred to as neuroleptics alluding to the tendency to produce neurological side effects, but not all antipsychotics are likely to produce such effects. Many of these drugs may also be effective against nausea, emesis, and pruritus. Antipsychotic,Antipsychotic Agent,Antipsychotic Drug,Antipsychotic Medication,Major Tranquilizer,Neuroleptic,Neuroleptic Agent,Neuroleptic Drug,Neuroleptics,Tranquilizing Agents, Major,Antipsychotic Drugs,Antipsychotic Effect,Antipsychotic Effects,Antipsychotics,Major Tranquilizers,Neuroleptic Agents,Neuroleptic Drugs,Tranquillizing Agents, Major,Agent, Antipsychotic,Agent, Neuroleptic,Drug, Antipsychotic,Drug, Neuroleptic,Effect, Antipsychotic,Major Tranquilizing Agents,Major Tranquillizing Agents,Medication, Antipsychotic,Tranquilizer, Major
D017063 Outcome Assessment, Health Care Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure). Assessment, Outcome,Outcome Assessment,Outcome Assessment (Health Care),Outcomes Research,Assessment, Outcomes,Outcome Measures,Outcome Studies,Outcomes Assessment,Assessment, Outcome (Health Care),Assessments, Outcome,Assessments, Outcome (Health Care),Assessments, Outcomes,Measure, Outcome,Measures, Outcome,Outcome Assessments,Outcome Assessments (Health Care),Outcome Measure,Outcome Study,Outcomes Assessments,Research, Outcomes,Studies, Outcome,Study, Outcome

Related Publications

C Okhuijsen-Pfeifer, and E A H Huijsman, and A Hasan, and I E C Sommer, and S Leucht, and R S Kahn, and J J Luykx
November 2016, The British journal of psychiatry : the journal of mental science,
C Okhuijsen-Pfeifer, and E A H Huijsman, and A Hasan, and I E C Sommer, and S Leucht, and R S Kahn, and J J Luykx
January 1999, International journal of psychiatry in clinical practice,
C Okhuijsen-Pfeifer, and E A H Huijsman, and A Hasan, and I E C Sommer, and S Leucht, and R S Kahn, and J J Luykx
November 2018, CNS drugs,
C Okhuijsen-Pfeifer, and E A H Huijsman, and A Hasan, and I E C Sommer, and S Leucht, and R S Kahn, and J J Luykx
September 2019, Schizophrenia research,
C Okhuijsen-Pfeifer, and E A H Huijsman, and A Hasan, and I E C Sommer, and S Leucht, and R S Kahn, and J J Luykx
August 2018, The Australian and New Zealand journal of psychiatry,
C Okhuijsen-Pfeifer, and E A H Huijsman, and A Hasan, and I E C Sommer, and S Leucht, and R S Kahn, and J J Luykx
February 2023, Journal of mental health (Abingdon, England),
C Okhuijsen-Pfeifer, and E A H Huijsman, and A Hasan, and I E C Sommer, and S Leucht, and R S Kahn, and J J Luykx
December 2017, Cancer treatment reviews,
C Okhuijsen-Pfeifer, and E A H Huijsman, and A Hasan, and I E C Sommer, and S Leucht, and R S Kahn, and J J Luykx
November 2021, Developmental medicine and child neurology,
C Okhuijsen-Pfeifer, and E A H Huijsman, and A Hasan, and I E C Sommer, and S Leucht, and R S Kahn, and J J Luykx
November 2022, Cancers,
C Okhuijsen-Pfeifer, and E A H Huijsman, and A Hasan, and I E C Sommer, and S Leucht, and R S Kahn, and J J Luykx
March 2016, Schizophrenia research,
Copied contents to your clipboard!