Open Access, Peer-reviewed

ISSN 2005-7571 (Online)
Volume 28, Number 2 (2/2021)
Original Article <page. 50-7 >
DOI : 10.22857/kjbp.2021.28.2.003

Prescription Pattern of 1 Year Clozapine Maintenance and Augmentation Agents in Schizophrenia Spectrum Disorders

Jaewon Kim, MD1,2;Se Hyun Kim, MD1,2;Jin-Hyeok Jang, MD3;Sun-Young Moon, MD1,2;Tae Uk Kang, MD4;Minah Kim, MD1,2; and Jun Soo Kwon, MD1,2,5;

1;Department of Psychiatry, Seoul National University Hospital, Seoul, 2;Department of Psychiatry, Seoul National University College of Medicine, Seoul, 3;B;less Hospital, Incheon, 4;Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, 5;Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Korea

Objectives : Clozapine is the most effective atypical antipsychotic agent for the treatment-resistant schizophrenia (TRS), however, only 40%–70% of TRS patients respond to clozapine. Moreover, TRS encompasses various symptom dimensions. Therefore, augmentation with other medications for clozapine is frequently applied. However, the prescription pattern of clozapine and combined medications in Korea is yet to be examined. This study aims to investigate the maintenance treatment pattern of clozapine and augmentation agents in one Korean tertiary hospital.

Methods : The patients with schizophrenia spectrum disorders under clozapine maintenance, defined as one-year clozapine continuation, were subjected for analysis. Medication data at one-year time-point after clozapine initiation was extracted and analyzed.

Results : Among total 2897 patients having clozapine prescription experience from January 2000 to December 2018, 1011 patients were on clozapine maintenance. The mean age of clozapine initiation was 30.2 ± 11.3 years, and the maintenance dose of clozapine was 217.8 ± 124.3 mg/day. Combination rate of antipsychotics, mood stabilizers, and antidepressants were 43.5%, 25.3%, 38.6%, respectively. Most frequently prescribed drugs in each category were aripiprazole, valproate, and sertraline. Olanzapine equivalent dose of combined antipsychotics was 10.4 ± 7.7 mg/day. Male patients were prescribed higher dose of combined antipsychotics and higher rate of antidepressants. Female patients had later onset of clozapine prescription. Patients with two or more combined antipsychotics were prescribed higher dose of clozapine and higher rate of antidepressants compared to patients with one combined antipsychotic.

Conclusions : Taken together, among the patients taking clozapine, a substantial rate of patients were under polypharmacy. The present findings based on the real-world prescription pattern could provide the valuable clinical information on the treatment of TRS-related conditions.

Key words : Schizophrenia;Clozapine;Antipsychotic;Polypharmacy.


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