• myGriffith
    • Staff portal
    • Contact Us⌄
      • Future student enquiries 1800 677 728
      • Current student enquiries 1800 154 055
      • International enquiries +61 7 3735 6425
      • General enquiries 07 3735 7111
      • Online enquiries
      • Staff phonebook
    View Item 
    •   Home
    • Griffith Research Online
    • Journal articles
    • View Item
    • Home
    • Griffith Research Online
    • Journal articles
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

  • All of Griffith Research Online
    • Communities & Collections
    • Authors
    • By Issue Date
    • Titles
  • This Collection
    • Authors
    • By Issue Date
    • Titles
  • Statistics

  • Most Popular Items
  • Statistics by Country
  • Most Popular Authors
  • Support

  • Contact us
  • FAQs
  • Admin login

  • Login
  • Clozapine Levels as a Predictor for Therapeutic Response: A Systematic Review and Meta-Analysis

    Thumbnail
    View/Open
    Kisely507629-Accepted.pdf (11.01Mb)
    File version
    Accepted Manuscript (AM)
    Author(s)
    Siskind, Dan
    Sharma, Meghna
    Pawar, Mrinal
    Pearson, Ella
    Wagner, Elias
    Warren, Nicola
    Kisely, Steve
    Griffith University Author(s)
    Kisely, Steve R.
    Year published
    2021
    Metadata
    Show full item record
    Abstract
    OBJECTIVES: Clozapine levels may be a more useful predictor of therapeutic response than the dose, given the variability in clozapine metabolism between individuals. We therefore systematically reviewed and meta-analysed the impact of clozapine levels on response and/or relapse to provide guidance on optimal clozapine levels. METHODS: We systematically searched PubMed, PsycInfo and Embase for studies exploring clozapine levels and response and/or relapse. Our primary meta-analysis was rates of response above and below clozapine level thresholds of 350ng/mL and 600ng/mL. Secondary analyses were undertaken of mean clozapine ...
    View more >
    OBJECTIVES: Clozapine levels may be a more useful predictor of therapeutic response than the dose, given the variability in clozapine metabolism between individuals. We therefore systematically reviewed and meta-analysed the impact of clozapine levels on response and/or relapse to provide guidance on optimal clozapine levels. METHODS: We systematically searched PubMed, PsycInfo and Embase for studies exploring clozapine levels and response and/or relapse. Our primary meta-analysis was rates of response above and below clozapine level thresholds of 350ng/mL and 600ng/mL. Secondary analyses were undertaken of mean clozapine levels, dose and concentration/dose (C/D) ratio and response and/or relapse. A meta-regression by study duration was conducted. RESULTS: Twenty studies met inclusion criteria. Clozapine levels above 350ng/mL were associated with statistically significantly higher rates of response (OR 2.27 95%CI 1.40-3.67, p<0.001), but not above 600ng/mL (OR 1.40 95%CI 0.85-2.31, p=0.19). Higher mean clozapine levels were associated with better rates of response (SMD 0.24, 95%CI 0.00-0.49, p=0.05), and lower rates of relapse (SMD -0.72, 95%CI -1.26 to -0.19, p=0.008). By contrast, neither clozapine dose nor C/D ratio were associated with differing rates of response. Similarly, study duration did not affect outcome. CONCLUSIONS: Our findings are in keeping with current guidelines that recommend targeting clozapine levels above 350ng/mL before augmentation is considered. As some clozapine associated ADRs are dose dependent, levels above 600ng/mL may have an unfavourable risk- benefit ratio.
    View less >
    Journal Title
    Acta Psychiatrica Scandinavica
    DOI
    https://doi.org/10.1111/acps.13361
    Copyright Statement
    © 2021 John Wiley and Sons. This is the peer reviewed version of the following article: Clozapine Levels as a Predictor for Therapeutic Response: A Systematic Review and Meta-Analysis, Acta Psychiatrica Scandinavica, 2021, which has been published in final form at https://doi.org/10.1111/acps.13361. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)
    Note
    This publication has been entered as an advanced online version in Griffith Research Online.
    Subject
    Health sciences
    Clozapine
    Levels
    Meta-Analysis
    Relapse
    Response
    Publication URI
    http://hdl.handle.net/10072/407002
    Collection
    • Journal articles

    Footer

    Disclaimer

    • Privacy policy
    • Copyright matters
    • CRICOS Provider - 00233E
    • TEQSA: PRV12076

    Tagline

    • Gold Coast
    • Logan
    • Brisbane - Queensland, Australia
    First Peoples of Australia
    • Aboriginal
    • Torres Strait Islander