Case-report of filigrastin use in Clozapine-related neutropenia

Poster A75, Thursday, October 20, 11:30 am - 1:00 pm, Le Baron

Marie-France Demers1,2,3,4, Lucie Fortier2, Ann-Sophie Breault2, Catherine Lehoux3,4, Sarah Grenier2, Marc-André Roy3,4,5; 1Faculté de pharmacie, Université Laval, Québec, 2Département de pharmacie, IUSMQ/CIUSSS-CN, Québec, 3Clinique Notre-Dame-des-Victoires, IUSMQ, CIUSSS-CN, Québec, 4CRIUSMQ, Québec, 5Département de Psychiatrie et Neurosciences, Université Laval, Québec

Clozapine is associated with a risk of neutropenia and agranulocytosis but remains the drug of choice for treatment-resistant schizophrenia. However, the occurrence of severe neutropenia may lead to treatment discontinuation, While there is increasing evidence that Clozapine re-challenge may be safely attempted in the majority of patients who experienced Clozapine-induced severe neutropenia, there is a dearth of evidence on other stratégies to manage such severe neutropenias. The case herein reported is a young man, who did not show significant response to antipsychotics within the first year of illness. Then, a first clozapine trial was attempted but terminated 6 months later due to neutropenia, after experiencing a significant yet incomplete response to Clozapine. A later clozapine re-challenge, two years later, led to a second episode of neutropenia that was successfully treated with two consecutive doses of filgrastim, a granulocyte colony-stimulating factor, that allowed successful maintenance of clozapine over a five-year follow-up. Algain, a significant yet incomplete response was obtained. The main improvements related to the disappearance of hostility, with PANSS score on this item dropping from 7 prior to the second Clozapine trial to 1 a few months later and thereafter. The total PANSS score dropped from 112 to 73, Over the last five years, the patient has never been re-hospitalized, and besides the two filigrastin injections during the week following the second neutropenia, no further neutropenia requiring further filigrastin injections occurred. This case suggests that filigrastin should be further investigated as a treatment for Clozapine related severe neutropenias.

Topic Area: First Episode Psychosis

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