Outcomes of Clozapine Treatment in Ethiopia: A Retrospective Study
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Date
2020-10
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Addis Abeba University
Abstract
Background:- Clozapine is a second-generation antipsychotic drug which was introduced in1961. It has wide clinical utility particularly for patients with treatment-resistant schizophrenia.Prescription of clozapine shows a considerable variation across countries. There is a general delayin its initiation partly because of its adverse effectsunavailability of clozapine and psychiatristattitudes towards the medication. Many studies have investigated clinical characteristics, adverse effect profile and treatment outcomes over time internationally. However, to the best of our knowledge, there is only one institution based study in Ethiopian.
Objective: To assess the outcomes of clozapine treatment in five health facilities in Ethiopia.
Method: A retrospective chart review was conducted from May to October, 2020 on patients who have been treated with clozapine between 2017 to 2020. Data extraction sheet was used toextract secondary data to assess indications, adverse effects and treatment outcomes of patientstreated with clozapine . SPSS version 25 was used for data entry andanalysis.
Results: A total of 84 patients treated with clozapine were recruited and the main indications weretreatment resistant schizophrenia(TRS) n=60 (71%), treatment resistant schizophrenia withtardive dyskinesia (TD) n=13(15.5%) and tardive dyskinesia n=10(11.9%). Seventy two (85.7%) patients had improvement of admission complaints upon discharge. The main improved symptoms were positive psychotic symptoms n=67(79.8%), negative symptoms n=52(61.9%), aggressionn=33(39.3%), suicidal behavior n= 11(13.1%), depressive symptoms n=20(23.8%) andimprovement of cognitive function n= 22(26. 2%). In case of TD patients, a mean AIMS scoreof 17.3 at admission reduced to 5.5 upon discharge. The most common side effects were sedation n=46(54.8%),sialorrhea n=31(36.9),constipation n=24(28.6%),weight gain n=18(21.4%) andtransient hematological abnormalities n=14(16.7%). Serious side effect found were seizure n=4(4.8%), persistent tachycardia n= 2(2.3%) and myocarditis n= 1(1.2%)
Conclusion and Recommendation:Clozapine was indicated for treatment of TRS and TD, which resulted in improvement ofadmission complaints. Most of the side effects were tolerable and manageable. The main identified reason for discontinuation of the medication was unavailability. Having seen the indications,tolerable adverse effects and better treatment outcomes of clozapine, we recommend that patientswith TRS and TD to be enrolled in clozapine treatment as soon as treatment-resistance isconfirmed.
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Clozapine Treatment