Clozapine and the Course of Bipolar Disorder in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD): La clozapine et l’évolution du trouble bipolaire dans le Programme d’amélioration systématique du traitement du trouble bipolaire (STEP-BD)

Author:

Costa Marta H.1,Kunz Mauricio1,Nierenberg Andrew A.2,Deckersbach Thilo2,Berk Michael34ORCID,Magalhaes Pedro V. S.1ORCID

Affiliation:

1. Graduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

2. Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

3. IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia

4. Orygen, The Centre of Excellence in Youth Mental Health, Department of Psychiatry and the Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia

Abstract

Objective: The potential of clozapine in severe bipolar disorder is suggested by its efficacy in refractory schizophrenia, but the evidence is limited thus far. This report utilizes data from the standard care pathway of the Systematic Treatment Enhancement Program to examine the clinical impact of clozapine in bipolar disorder, comparing it to two groups, one that received olanzapine and an additional group that received neither drug. Method: A total of 4,032 outpatients were available for this analysis. Groups for longitudinal analyses are based on the medication used at each visit. Outcomes assessed were clinical status, symptoms subscales, hospitalizations, and death. We utilized mixed models and generalized estimating equations to adjust for baseline differences and investigate longitudinal differences in symptoms, clinical status, and hospitalization rates between groups. Results: During the study, 1.1% ( n = 43) of the patients used clozapine at any time. Those on clozapine had significantly fewer manic and depressive symptoms during follow-up as compared with those on neither clozapine nor olanzapine, while those on olanzapine had more symptoms. The use of clozapine was not associated with an increased risk of hospitalization. No deaths were recorded for clozapine group during the trial. Conclusions: Although prescribed to very few patients, the impact of clozapine was notable, with fewer symptoms in patients who had more severe illnesses at baseline. Clozapine could prove to be as successful an intervention for late-stage bipolar disorder as it has been in schizophrenia.

Publisher

SAGE Publications

Subject

Psychiatry and Mental health

Cited by 4 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. The EASE model for optimum use of clozapine: A clinician perspective;Schizophrenia Research;2023-11

2. Clozapine for management of bipolar disorder: A case series;Journal of SAARC Psychiatric Federation;2023

3. Place of care and costs associated with acute episodes and remission in bipolar I disorder;Journal of Medical Economics;2022-09-22

4. The Modernization of Clozapine;Journal of Clinical Psychopharmacology;2022-09-16

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