Outcome following clozapine discontinuation: a retrospective analysis.
BACKGROUND
Clozapine is uniquely effective in refractory schizophrenia, but treatment attrition is high. There has been minimal formal study of the outcomes of stopping clozapine, beyond published observations of the time period immediately after cessation. Our aim was to establish medium-term outcome in patients stopping clozapine in normal clinical practice.


METHODS
This study was a retrospective analysis of all subjects registered with Clozaril Patient Monitoring Service and treated in South London and Maudsley National Health Service (NHS) Trust who stopped clozapine between March 2002 and March 2005 after at least 1 year's treatment. Case note review was performed to determine relevant information for 1 year before and 1 year after discontinuation of clozapine, including subject details, reasons for stopping, and clinical outcome 1 year after discontinuation. The primary outcome measure was the Global Assessment of Functioning scale.


RESULTS
Thirty-five patients met inclusion criteria. Twelve had died while receiving clozapine. Of those followed up for 1 year after cessation (N = 23), mean Global Assessment of Functioning scores fell by 15 points (95% CI = 6.6 to 24.3; p = .002). Days spent in hospital rose from a mean of 74.1 (SD = 137.3) to 119.8 (SD = 143.5) (p = .214).


CONCLUSIONS
Discontinuation of clozapine has a marked negative impact on clinical status. Death is a common cause of clozapine cessation.
South London and Maudsley National Health Service (NHS) Trust, Pharmacy Department, Maudsley Hospital, London, United Kingdom. jamesatkinson@nhs.net
James M
JM
Atkinson
Petrina
P
Douglas-Hall
Catrin
C
Fischetti
Anna
A
Sparshatt
David M
DM
Taylor
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002423:Cause of Death; D003024:Clozapine / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy* / Q000401:mortality*; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003024:Clozapine