Higher orexin-A levels are associated with treatment response to clozapine in patients with schizophrenia: A cross-sectional study

• Published in: Journal of psychopharmacology (Oxford) Vol. 38; no. 3; p. 258
• Main Authors: Chen, Po-Yu, Chiu, Chih-Chiang, Chang, Chin-Kuo, Lu, Mong-Liang, Huang, Cho-Yin, Chen, Chun-Hsin, Huang, Ming-Chyi
• Format: Journal Article
• Language: English
• Published: United States 01.03.2024
• Subjects: Antipsychotic Agents - therapeutic use; Clozapine - therapeutic use; Cross-Sectional Studies; Humans; Orexins - therapeutic use; Prospective Studies; Schizophrenia - complications; Cognition; Treatment response; Clozapine; Treatment-resistant schizophrenia; Orexin-A
• ISSN: 1461-7285
• DOI: 10.1177/02698811231225610

Clozapine is the primary antipsychotic (APD) for treatment-resistant schizophrenia (TRS). However, only 40% of patients with TRS respond to clozapine, constituting a subgroup of clozapine-resistant patients. Recently, the neuropeptide orexin-A was shown to be involved in the pathophysiology of schizophrenia. This study evaluated the association of orexin-A levels with the clozapine response in patients with TRS. We recruited 199 patients with schizophrenia, including 37 APD-free and 162 clozapine-treated patients. Clozapine-treated patients were divided into clozapine-responsive (  = 100) and clozapine-resistant (  = 62) groups based on whether they had achieved psychotic remission defined by the 18-item Brief Psychiatric Rating Scale (BPRS-18). We compared blood orexin-A levels among the three groups and performed regression analysis to determine the association of orexin-A level with treatment response in clozapine-treated patients. We also explored the correlation between orexin-A levels and cognitive function, assessed using the CogState Schizophrenia Battery. Clozapine-responsive patients had higher orexin-A levels than clozapine-resistant and APD-free patients. Orexin-A level was the only factor significantly associated with treatment response after adjustment. Orexin-A levels were negatively correlated with BPRS-18 full scale and positive, negative, and general symptoms subscale scores. We also observed a positive correlation between orexin-A levels and verbal memory, visual learning and memory, and working memory function. This cross-sectional study showed that higher levels of orexin-A are associated with treatment response to clozapine in patients with TRS. Future prospective studies examining changes in orexin-A level following clozapine treatment and the potential benefit of augmenting orexin-A signaling are warranted.