A new study reveals the underuse of a key drug in patients with treatment-resistant schizophrenia

The Psychiatry and Mental Health research group at the Germans Trias i Pujol Research Institute (IGTP), together with the ETEP (Study and Treatment of Psychotic Episodes) group at Hospital del Mar, has published a study in the Spanish Journal of Psychiatry and Mental Health that analyses the use of clozapine in patients with treatment-resistant schizophrenia in the first two years after the first psychotic episode (FEP).

The study analyses the prescription patterns of clozapine in patients diagnosed with an FEP. The main objective was to determine the proportion of patients receiving clozapine, the initial predictors of its use, the time until its initiation, the medications taken simultaneously, and the associated adverse effects.

The main findings of this research are as follows:

• Of 255 patients, only 78% received clozapine, despite 302% being treatment-resistant.
• A lower score on the Global Assessment of Functioning (GAF) Scale was correlated with clozapine use in the first two years.
• The median time to clozapine initiation was 55 days.
• The most common side effects were sedation and metabolic alterations, including an increase in body mass index (BMI) and triglycerides.

Graphical abstract

"Approximately 20-30% of patients with schizophrenia do not respond to conventional antipsychotic treatments and are considered treatment-resistant. In these cases, clozapine is the treatment of choice, but its use in real clinical practice is often delayed or insufficient," explains Dr Alba Toll, head of the Psychiatry and Mental Health Research Group at IGTP and one of the principal authors of the study. "One of the reasons for the underuse of clozapine is the reluctance of both clinicians and patients to start treatment due to its potential side effects, such as sedation and metabolic alterations."

However, the use of clozapine in the early years after the first psychotic episode can significantly reduce psychotic symptoms in these patients and improve their quality of life: "Despite the difficulties, the use of clozapine in the early stages after a first psychotic episode is essential to improve the long-term prognosis of patients with treatment-resistant schizophrenia. Therefore, it is very important to promote strategies that help implement this treatment more broadly and early, such as training health professionals and raising awareness among patients and their families about the potential benefits of the treatment."

This study highlights the underuse of clozapine despite its benefits in improving psychotic symptoms and the quality of life for patients with treatment-resistant. The authors emphasize the need for more training and awareness for a broader and earlier implementation of clozapine in clinical practice.