The impact of clozapine on hospital use: a systematic review and meta-analysis.
OBJECTIVE
The objective of this study was to perform a systematic review and meta-analysis of studies reporting the impact of clozapine on hospital use in people with a psychotic illness.


METHODS
PubMed, EMBASE, PsycINFO and the Cochrane Schizophrenia Group Trials Register were systematically searched from inception to 12 October 2016. We included all trials and observational studies, except case reports.


RESULTS
Thirty-seven studies were included. Clozapine significantly reduced the proportion of people hospitalised compared to control medicines (RR = 0.74; 95% CI: 0.69-0.80, P < 0.001, 22 studies, n = 44 718). There were significantly fewer bed days after clozapine treatment compared to before clozapine treatment in both controlled (MD = -34.41 days; 95% CI: -68.22 to -0.60 days, P = 0.046, n = 162) and uncontrolled studies (MD = -52.86 days; 95% CI: -79.86 days to -25.86 days, P < 0.001, n = 2917). Clozapine and control medicines had a similar time to rehospitalisation (-19.90 days; 95% CI: -62.42 to 22.63 days, P = 0.36).


CONCLUSIONS
Clozapine treatment reduced the number of people hospitalised and the number of bed days after treatment compared with before treatment. Clozapine has the potential to reduce acute hospital use among people with treatment refractory schizophrenia.
School of Pharmacy, University of Queensland, Woolloongabba, Qld, Australia.
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Land
School of Medicine, University of Queensland, Herston, Qld, Australia.|Metro South Addiction and Mental Health Services, Woolloongabba, Qld, Australia.
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Siskind
School of Medicine, University of Queensland, Herston, Qld, Australia.|Metro South Addiction and Mental Health Services, Woolloongabba, Qld, Australia.
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McArdle
School of Medicine, University of Queensland, Herston, Qld, Australia.|Metro South Addiction and Mental Health Services, Woolloongabba, Qld, Australia.
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Kisely
School of Pharmacy, University of Queensland, Woolloongabba, Qld, Australia.|Pharmacy Department, Princess Alexandra Hospital, Woolloongabba, Qld, Australia.
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Winckel
School of Pharmacy, University of Queensland, Woolloongabba, Qld, Australia.
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http://orcid.org/0000-0002-5226-5663
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Hollingworth
D014150:Antipsychotic Agents / Q000008:administration & dosage*; D003024:Clozapine / Q000008:administration & dosage*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D064887:Observational Studies as Topic; D011618:Psychotic Disorders / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003024:Clozapine
clozapine; hospital use; meta-analysis; psychotic disorders; schizophrenia