O5.1. clozapine and long-term mortality risk in patients with schizophrenia: preliminary results from a meta-analysis

The objectives of the current study were to determine in i) all-cause long-term mortality rates and ii) specific-cause mortality rates and ratios in patients with schizophrenia with and without clozapine treatment.MethodsWe systematically searched EMBASE, MEDLINE and PsycINFO and included studies that used a long-term follow-up design (i.e., ≥52 weeks) and reported on mortality in adults diagnosed with schizophrenia-spectrum disorders receiving clozapine treatment.ResultsAltogether, 23 studies fulfilled our criteria, reporting on 1,166 deaths during 203,231 patient years for patients treated with clozapine. Pooling five cohort studies that included sufficient sample sizes and length of follow-up, we found an unadjusted mortality rate of 7.34 per 1,000 patient years (95%CI=4.39 –10.28). Long-term, crude mortality rate ratios were significantly lower in patients treated with clozapine compared to patients without clozapine treatment (mortality rate ratio=0.59, 95%CI=0.43–0.81, p-value<0.001) as well as compared to other antipsychotic medications (mortality rate ratio=0.61, 95%CI=0.45 –0.84, p-value=0.002). We found incomplete and inconsistent reporting of specific-cause mortality rates. Statistical heterogeneity was high in all analyses.DiscussionFuture studies with substantial length of follow-up and uniform reporting of confounders are needed to validate these findings of a significantly lower mortality risk in patients using clozapine, in particular for the risk o...
Source: Schizophrenia Bulletin - Category: Psychiatry Source Type: research