Clozapine use in Early-Intervention programs across Canada

Poster A104, Thursday, October 20, 11:30 am - 1:00 pm, Le Baron

Marc-André Roy1,3, Amélie Achim1, Ridha Joober2, Marie-France Demers1,3, Amal Abdel Baki4, Thomas Raedler5, Nicola Banks6, Phil Tibbo7, Offer Agid8, Ashok Malla2, Richard Williams9; 1CNDV and Département de Psychiatrie et Neurosciences; Université Laval, Québec, Québec, 2Douglas Hospital PEPP program, Department of Psychiatry McGill University, Montréal, Québec, 3CNDV et Faculté de pharmacie, Universét Laval, Québec, Québec, Québec, 4Clinique JAP/CHUM et département de psychiatrie, Université de Montréal, Montréal, Québec, 5University of Calgary, Calgary, Alberta, 6Myelin, Toronto, Ontaria, 7Dalhousie University, Halifax, Nova Scotia, 8Center for Addiction and Mental Health, Toronto, Ontario, 9University of British Columbia, Victoria, British Columiba

Clozapine remains to this day the treatment of choice for people with schizophrenia who have failed to respond to two consecutive antipsychotic trials. It is estimated that it should be used in 20% of patients given the prevalence of treatment-resistance in schizophrenia. Although it tends to be introduced at a relatively late stage of illness it has been observed that as many as 20% of people with first-episode psychosis may fail to respond to two consecutive trials. Hence, conducted a survey to determine the rate of use of Clozapine across 11 early intervention programs in Canada (total n = 1771). We obtained a weighted mean rate of 13.5% of patients receiving Clozapine (95% CI: 7.1%, 19%) but with highly significant heterogeneity (p below 0.00001) using Fleiss’ method to derive mean prevalence estimates by pooling patient samples. In seeking to account for this heterogeneity, we observed higher rates of Clozapine use in the programs using a systematic algorithm to assess treatment resistance (17.2% vs. 10.6%), in those with dedicated hospital beds (18,0% vs. 9.5%) and in those with a program follow up longer than two years (14.8% vs. 6.2%). The is survey thus documented rates of Clozapine use in these early intervention programs than are even greater than the rates observed in other settings including more chronic patients. Furthermore, it provides possible leads to guide optimal Clozapine use in early intervention programs which need to be further explored.

Topic Area: First Episode Psychosis

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