The impact of clozapine on hospital use: a systematic review and meta-analysis

Land, R., Siskind, D., McArdle, P., Kisely, S., Winckel, K. and Hollingworth, S. A. (2017) The impact of clozapine on hospital use: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 135 4: 296-309. doi:10.1111/acps.12700

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Author Land, R.
Siskind, D.
McArdle, P.
Kisely, S.
Winckel, K.
Hollingworth, S. A.
Title The impact of clozapine on hospital use: a systematic review and meta-analysis
Journal name Acta Psychiatrica Scandinavica   Check publisher's open access policy
ISSN 1600-0447
0001-690X
Publication date 2017-03-02
Year available 2017
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1111/acps.12700
Open Access Status File (Author Post-print)
Volume 135
Issue 4
Start page 296
End page 309
Total pages 14
Place of publication Hoboken, NJ United States
Publisher Wiley-Blackwell Publishing
Language eng
Subject 2738 Psychiatry and Mental health
Abstract 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. Method: 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). Conclusion: 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.
Formatted abstract
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.

Method

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).

Conclusion

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.
Keyword Schizophrenia
Psychotic disorders
Clozapine
Hospital use
Meta-analysis
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID APP1111136
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: HERDC Pre-Audit
School of Pharmacy Publications
School of Clinical Medicine Publications
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Created: Sat, 11 Feb 2017, 13:46:09 EST by Dan Siskind on behalf of PAH-Southside Clinical Unit