Clinical impact of reducing the frequency of clozapine monitoring: controlled mirror-image cohort study

Ebenezer Oloyede; Olubanke Dzahini; Zadro Abolou; Siobhan Gee; Eromona Whiskey; Diksha Malhotra; Masuma Hussain; Ian Osborne; Cecilia Casetta; Philip McGuire; James H MacCabe; David Taylor

doi:10.1192/bjp.2023.44

Clinical impact of reducing the frequency of clozapine monitoring: controlled mirror-image cohort study

Ebenezer Oloyede, Olubanke Dzahini, Zadro Abolou, Siobhan Gee, Eromona Whiskey, Diksha Malhotra, Masuma Hussain, Ian Osborne, Cecilia Casetta, Philip McGuire, James H MacCabe, David Taylor

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Abstract

BACKGROUND: To minimise infection during COVID-19, the clozapine haematological monitoring interval was extended from 4-weekly to 12-weekly intervals in South London and Maudsley NHS Foundation Trust.

AIMS: To investigate the impact of this temporary policy change on clinical and safety outcomes.

METHOD: All patients who received clozapine treatment with extended (12-weekly) monitoring in a large London National Health Service trust were included in a 1-year mirror-image study. A comparison group was selected with standard monitoring. The proportion of participants with mild to severe neutropenia and the proportion of participants attending the emergency department for clozapine-induced severe neutropenia treatment during the follow-up period were compared. Psychiatric hospital admission rates, clozapine dose and concomitant psychotropic medication in the 1 year before and the 1 year after extended monitoring were compared. All-cause clozapine discontinuation at 1-year follow-up was examined.

RESULTS: Of 569 participants, 459 received clozapine with extended monitoring and 110 controls continued as normal. The total person-years were 458 in the intervention group and 109 in the control group, with a median follow-up time of 1 year in both groups. During follow-up, two participants (0.4%) recorded mild to moderate neutropenia in the intervention group and one (0.9%) in the control group. There was no difference in the incidence of haematological events between the two groups (IRR = 0.48, 95% CI 0.02-28.15, P = 0.29). All neutropenia cases in the intervention group were mild, co-occurring during COVID-19 infection. The median number of admissions per patient during the pre-mirror period remained unchanged (0, IQR = 0) during the post-mirror period. There was one death in the control group, secondary to COVID-19 infection.

CONCLUSIONS: There was no evidence that the incidence of severe neutropenia was increased in those receiving extended monitoring.

Original language	English
Pages (from-to)	382-388
Number of pages	7
Journal	The British journal of psychiatry : the journal of mental science
Volume	223
Issue number	2
Early online date	24 Apr 2023
DOIs	https://doi.org/10.1192/bjp.2023.44
Publication status	Published - 24 Aug 2023

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Oloyede et al 2023 37092691Final published version, 587 KBLicence: CC BY

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Oloyede, E., Dzahini, O., Abolou, Z., Gee, S., Whiskey, E., Malhotra, D., Hussain, M., Osborne, I., Casetta, C., McGuire, P., MacCabe, J. H., & Taylor, D. (2023). Clinical impact of reducing the frequency of clozapine monitoring: controlled mirror-image cohort study. The British journal of psychiatry : the journal of mental science, 223(2), 382-388. https://doi.org/10.1192/bjp.2023.44

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title = "Clinical impact of reducing the frequency of clozapine monitoring: controlled mirror-image cohort study",

abstract = "BACKGROUND: To minimise infection during COVID-19, the clozapine haematological monitoring interval was extended from 4-weekly to 12-weekly intervals in South London and Maudsley NHS Foundation Trust.AIMS: To investigate the impact of this temporary policy change on clinical and safety outcomes.METHOD: All patients who received clozapine treatment with extended (12-weekly) monitoring in a large London National Health Service trust were included in a 1-year mirror-image study. A comparison group was selected with standard monitoring. The proportion of participants with mild to severe neutropenia and the proportion of participants attending the emergency department for clozapine-induced severe neutropenia treatment during the follow-up period were compared. Psychiatric hospital admission rates, clozapine dose and concomitant psychotropic medication in the 1 year before and the 1 year after extended monitoring were compared. All-cause clozapine discontinuation at 1-year follow-up was examined.RESULTS: Of 569 participants, 459 received clozapine with extended monitoring and 110 controls continued as normal. The total person-years were 458 in the intervention group and 109 in the control group, with a median follow-up time of 1 year in both groups. During follow-up, two participants (0.4%) recorded mild to moderate neutropenia in the intervention group and one (0.9%) in the control group. There was no difference in the incidence of haematological events between the two groups (IRR = 0.48, 95% CI 0.02-28.15, P = 0.29). All neutropenia cases in the intervention group were mild, co-occurring during COVID-19 infection. The median number of admissions per patient during the pre-mirror period remained unchanged (0, IQR = 0) during the post-mirror period. There was one death in the control group, secondary to COVID-19 infection. CONCLUSIONS: There was no evidence that the incidence of severe neutropenia was increased in those receiving extended monitoring.",

author = "Ebenezer Oloyede and Olubanke Dzahini and Zadro Abolou and Siobhan Gee and Eromona Whiskey and Diksha Malhotra and Masuma Hussain and Ian Osborne and Cecilia Casetta and Philip McGuire and MacCabe, {James H} and David Taylor",

note = "Publisher Copyright: Copyright {\textcopyright} The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.",

year = "2023",

month = aug,

day = "24",

doi = "10.1192/bjp.2023.44",

language = "English",

volume = "223",

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journal = "The British journal of psychiatry : the journal of mental science",

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Oloyede, E, Dzahini, O, Abolou, Z, Gee, S , Whiskey, E, Malhotra, D, Hussain, M, Osborne, I, Casetta, C, McGuire, P, MacCabe, JH & Taylor, D 2023, 'Clinical impact of reducing the frequency of clozapine monitoring: controlled mirror-image cohort study', The British journal of psychiatry : the journal of mental science, vol. 223, no. 2, pp. 382-388. https://doi.org/10.1192/bjp.2023.44

TY - JOUR

T1 - Clinical impact of reducing the frequency of clozapine monitoring

T2 - controlled mirror-image cohort study

AU - Oloyede, Ebenezer

AU - Dzahini, Olubanke

AU - Abolou, Zadro

AU - Gee, Siobhan

AU - Whiskey, Eromona

AU - Malhotra, Diksha

AU - Hussain, Masuma

AU - Osborne, Ian

AU - Casetta, Cecilia

AU - McGuire, Philip

AU - MacCabe, James H

AU - Taylor, David

PY - 2023/8/24

Y1 - 2023/8/24

N2 - BACKGROUND: To minimise infection during COVID-19, the clozapine haematological monitoring interval was extended from 4-weekly to 12-weekly intervals in South London and Maudsley NHS Foundation Trust.AIMS: To investigate the impact of this temporary policy change on clinical and safety outcomes.METHOD: All patients who received clozapine treatment with extended (12-weekly) monitoring in a large London National Health Service trust were included in a 1-year mirror-image study. A comparison group was selected with standard monitoring. The proportion of participants with mild to severe neutropenia and the proportion of participants attending the emergency department for clozapine-induced severe neutropenia treatment during the follow-up period were compared. Psychiatric hospital admission rates, clozapine dose and concomitant psychotropic medication in the 1 year before and the 1 year after extended monitoring were compared. All-cause clozapine discontinuation at 1-year follow-up was examined.RESULTS: Of 569 participants, 459 received clozapine with extended monitoring and 110 controls continued as normal. The total person-years were 458 in the intervention group and 109 in the control group, with a median follow-up time of 1 year in both groups. During follow-up, two participants (0.4%) recorded mild to moderate neutropenia in the intervention group and one (0.9%) in the control group. There was no difference in the incidence of haematological events between the two groups (IRR = 0.48, 95% CI 0.02-28.15, P = 0.29). All neutropenia cases in the intervention group were mild, co-occurring during COVID-19 infection. The median number of admissions per patient during the pre-mirror period remained unchanged (0, IQR = 0) during the post-mirror period. There was one death in the control group, secondary to COVID-19 infection. CONCLUSIONS: There was no evidence that the incidence of severe neutropenia was increased in those receiving extended monitoring.

AB - BACKGROUND: To minimise infection during COVID-19, the clozapine haematological monitoring interval was extended from 4-weekly to 12-weekly intervals in South London and Maudsley NHS Foundation Trust.AIMS: To investigate the impact of this temporary policy change on clinical and safety outcomes.METHOD: All patients who received clozapine treatment with extended (12-weekly) monitoring in a large London National Health Service trust were included in a 1-year mirror-image study. A comparison group was selected with standard monitoring. The proportion of participants with mild to severe neutropenia and the proportion of participants attending the emergency department for clozapine-induced severe neutropenia treatment during the follow-up period were compared. Psychiatric hospital admission rates, clozapine dose and concomitant psychotropic medication in the 1 year before and the 1 year after extended monitoring were compared. All-cause clozapine discontinuation at 1-year follow-up was examined.RESULTS: Of 569 participants, 459 received clozapine with extended monitoring and 110 controls continued as normal. The total person-years were 458 in the intervention group and 109 in the control group, with a median follow-up time of 1 year in both groups. During follow-up, two participants (0.4%) recorded mild to moderate neutropenia in the intervention group and one (0.9%) in the control group. There was no difference in the incidence of haematological events between the two groups (IRR = 0.48, 95% CI 0.02-28.15, P = 0.29). All neutropenia cases in the intervention group were mild, co-occurring during COVID-19 infection. The median number of admissions per patient during the pre-mirror period remained unchanged (0, IQR = 0) during the post-mirror period. There was one death in the control group, secondary to COVID-19 infection. CONCLUSIONS: There was no evidence that the incidence of severe neutropenia was increased in those receiving extended monitoring.

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Clinical impact of reducing the frequency of clozapine monitoring: controlled mirror-image cohort study

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