RESEARCH WEEKLY: Clozapine and COVID-19 By Elizabeth Sinclair Hancq Clozapine treatment does not pose as an additional risk for COVID-19 and treatment should be continued during the COVID-19 pandemic, according to new research published earlier this year. Clozapine is the only antipsychotic medication that is evidence-based for treatment-refractory schizophrenia, which occurs in approximately one in three people with the illness. In addition, it is the only antipsychotic medication FDA-approved to reduce suicidal behavior in people with severe mental illness. In addition to reducing suicidality and psychosis symptoms, previous research has shown that clozapine reduces violent behavior, inpatient hospitalization and overall mortality risks. However, a rare side effect of clozapine is a risk of agranulocytosis, which is a disruption to an individual’s immune system. For this reason, careful monitoring of individuals taking clozapine is required by the FDA, including regular blood tests. Some other research suggests people taking clozapine may be more at risk for viral infection, although the results have been mixed. Regardless, it is important to understand whether people with schizophrenia undergoing clozapine treatment are at higher risk of COVID-19 infection or severe outcomes if infected. Researchers from Sweden examined this question utilizing data from the country’s health register within Stockholm, which includes data on more than two million individuals. The study authors compared outcomes of individuals with schizophrenia who were undergoing clozapine treatment to those that had been taking other forms of antipsychotic medications. The authors found no difference in risk for severe COVID-19 or death in individuals in clozapine treatment compared to those taking other antipsychotic medications after controlling for other factors such as age or if they lived in a nursing home. If an individual needed hospitalization or an intensive care unit (ICU) stay because of COVID-19 then they were considered to have severe COVID-19. Despite utilizing Sweden’s health register and having a very large sample size, the number of cases of individuals with schizophrenia needing hospitalization due to COVID-19 was low and impacts the statistical power of the results. However, due to the comprehensiveness of the health register, the study authors were able to control for a variety of potential risks that may have cofounded the findings. The authors were also unable to determine clozapine treatment length and how that might impact COVID-19 risk. This is important because the risk for agranulocytosis is mainly when an individual first starts clozapine treatment and reduces significantly over time. The results of this study support the recommendation for continuing clozapine treatment during the COVID-19 pandemic, adding to the body of research where “no findings have so far supported the termination of ongoing clozapine treatment albeit theoretical risks,” according to the study authors. In fact, the potential relapse of psychotic symptoms in patients who discontinue clozapine would both cause distress to the individual and their loved ones as well as make delivering lifesaving COVID-19 treatment more difficult if it is needed. “Overall, it is our opinion that the dangers of discontinuing clozapine treatment likely outweigh the risks of continued clozapine treatment under careful monitoring,” the authors conclude. References Ohlis, A., et al. (2021, October). Clozapine treatment and risk of severe COVID-19 infection. Acta Psychiatrica Scandinavica. Elizabeth Sinclair Hancq is the director of research at the Treatment Advocacy Center. View as Webpage To receive Research Weekly directly in your email inbox on a weekly basis, click here. Questions? Contact us at [email protected] Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications. The Treatment Advocacy Center does not solicit or accept funds from pharmaceutical companies. Treatment Advocacy Center | 200 N Glebe Rd, Ste 801, Arlington, VA 22203 Unsubscribe [email protected] Update Profile | Constant Contact Data Notice Sent by [email protected] powered by Try email marketing for free today!