Temporal trends in clozapine use at time of discharge among people with schizophrenia at two public psychiatric hospitals in Taiwan, 2006-2017

• Published in: Scientific reports Vol. 10; no. 1; p. 17984
• Main Authors: Lin, Ching-Hua, Chan, Hung-Yu, Hsu, Chun-Chi, Chen, Feng-Chua
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 22.10.2020; Nature Publishing Group UK
• Subjects: Adult; Anticholinergics; Antipsychotic Agents - therapeutic use; Antipsychotics; Clozapine; Clozapine - therapeutic use; Drug Therapy, Combination; Female; Hospitals; Hospitals, Psychiatric - trends; Hospitals, Public - trends; Humans; Male; Mental disorders; Patient Discharge; Patients; Psychotropic drugs; Schizophrenia; Schizophrenia - drug therapy; Schizophrenia - epidemiology; Schizophrenia - pathology; Taiwan - epidemiology; Trends; Taiwan
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-75022-8

Clozapine treatment remains the gold standard for treatment-resistant schizophrenia. This study aimed to describe temporal trends in clozapine use at discharge among patients with schizophrenia at two of the largest public psychiatric hospitals in Taiwan over a twelve-year period. Patients with schizophrenia discharged from the two study hospitals between 2006 and 2017 (n = 24,101) were included in the analysis. Antipsychotic augmentation was defined as concomitant use of a second antipsychotic as augmentation to clozapine treatment. Changes in the rate of clozapine use and antipsychotic augmentation at discharge over time were analyzed using the Cochran-Armitage trend test. Patients discharged on clozapine had significantly longer hospital stays than other patients. The rate of clozapine use at discharge increased from 13.8% to 20.0% over time (Z = 6.88, p < .0001). Concomitant use of anticholinergic medication was more common in patients receiving antipsychotic augmentation than clozapine antipsychotic monotherapy. Among patients discharged on clozapine, the rate of augmentation with a second antipsychotic increased from 19.1% to 36.2% over time (Z = 6.58, p < .0001). Among patients receiving antipsychotic augmentation, use of another second-generation antipsychotic as the augmentation agent grew from 32.6% to 65.5% over time (Z = 8.90, p < .0001). The increase in clozapine use was accompanied by an increase in concomitant use of a second antipsychotic as augmentation during the study period. Further studies are warranted to clarify the risk/benefit of this augmentation strategy. Clozapine may still be underutilized, and educational programs are needed to promote clinical use of clozapine.