Portal de Periódicos da CAPES

Clozapine Optimization: A Delphi Consensus Guideline From the Treatment Response and Resistance in Psychosis Working Group

2023; Oxford University Press; Volume: 49; Issue: 4 Linguagem: Inglês

10.1093/schbul/sbad030

1745-1701

Elias Wagner, Dan Siskind, Peter Falkai, Oliver Howes, Christoph U. Correll, Jimmy Lee, William G. Honer, John M. Kane, Emilio Fernández-Egea, Thomas R. E. Barnes, Alkomiet Hasan, Ofer Agid, Celso Arango, Lone Baandrup, Thomas R. E. Barnes, Andrea de Bartolomeis, Nico J.M. van Beveren, Michael L. Birnbaum, István Bitter, Alain Breier, Robert W. Buchanan, William T. Carpenter, David Castle, Eric Chen, Leslie Citrome, David Cotter, Christoph U. Correll, Benedicto Crespo‐Facorro, Michael Davidson, Richard Drake, Sonia Dollfus, Serdar Dursun, Bjørn H. Ebdrup, Robin Emsley, Emilio Fernández-Egea, Hélio Elkis, Peter Falkai, Wolfgang Fleischhacker, Oliver Freudenreich, Ary Gadelha, Wolfgang Gäebel, Birte Glenthøj, Donald Goff, Ariel Graff‐Guerrero, Jorge Hallak, Alkomiet Hasan, William G. Honer, Philip Homan, Oliver Howes, René S. Kahn, Stefan Kaiser, John M. Kane, James L. Kennedy, Bruce J. Kinon, Euitae Kim, Stephen M. Lawrie, Jimmy Lee, Stefan Leucht, F. Markus Leweke, Jan Libiger, Antony Loebel, James H. MacCabe, Stephen R. Marder, Robert A. McCutcheon, Ingrid Melle, Herbert Y. Meltzer, Armida Mucci, Dieter Naber, Shinchiro Nakajima, Jimmi Nielsen, Oisín O’Brien, Akin Ojagbemi, Christos Pantelis, Joseph Peuskens, Steven G. Potkin, Tiago Reis Marques, Thomas J. Raedler, Gary Remington, Susan L. Rossell, Jose Rubio-Lorente, Gabriele Sachs, Dan Siskind, Cynthia Siu, Iris E. Sommer, Jun Soo Kwon, Takefumi Suzuki, Jaana Suvisaari, Hiroyoshi Takeuchi, Rajiv Tandon, David Taylor, Neil Thomas, Jari Tiihonen, Hiroyuki Uchida, Alp Üçok, Daniel Umbricht, Ganesan Venkatasubramanian, Elias Wagner, James Walters, Chuanyue Wang, Emmanuelle Weiller, Mark Weiser,

Psychiatric care and mental health services

Abstract Background and Hypothesis There is limited evidence to guide the approaches to clozapine treatment. Accordingly, an international initiative was undertaken with the aim of developing consensus recommendations for the optimization of clozapine monotherapy. Study Design We conducted an online Delphi survey among members of the Treatment Response and Resistance in Psychosis (TRRIP) working group comprising experts from twenty-nine countries. The threshold criterion for a consensus recommendation was ≥ 75% agreement (“agree” and “strongly agree” responses) on a question. Agreement of ≥ 50% but < 75% in a second or third Delphi round was deemed to provide guidance. Study Results Forty-nine (first round), 32 (second round), and 48 (third round) of the 91 current TRRIP members participated. Expert recommendations at ≥ 75% comprised second-line treatment with clozapine in cases of persistent positive symptoms with co-occurring extrapyramidal symptoms, tardive dyskinesia, or suicidality/aggression. There was considerable disagreement on myocarditis screening parameters. The management of somatic and neuropsychiatric adverse drug reactions warrants further research for more evidence-based recommendations. Rechallenge with clozapine was recommended for eosinophilia, sinus tachycardia and fever and guidance (agreement ≥ 50%) was reached for pneumonia and thrombocytopenia. Conclusions Given the limited evidence available, this consensus-based series of recommendations and guidance statements supports clinical decision-making to optimize clozapine monotherapy and provides guidance for future research in treatment-resistant schizophrenia.