An expert review of clozapine in Eastern European countries: Use, regulations and pharmacovigilance.
Objectives: To compare the prevalence, regulations, and pharmacovigilance practices of clozapine use in Eastern European countries (except Russia). Methods: Questionnaires and data from administrative databases (2016 and 2021), package inserts and national guidelines were collected from 16 co-author...
| Autores: | , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Fecha de publicación: | 2023 |
| País: | España |
| Institución: | Universidad de La Laguna (ULL) |
| Repositorio: | RIULL. Repositorio Institucional de la Universidad de La Laguna |
| OAI Identifier: | oai:riull.ull.es:915/39565 |
| Acceso en línea: | http://riull.ull.es/xmlui/handle/915/39565 |
| Access Level: | acceso abierto |
| Palabra clave: | clozapine/adverse effects clozapine/administration and dosage clozapine/therapeutic use drug labeling Europe, Eastern schizophrenia |
| Sumario: | Objectives: To compare the prevalence, regulations, and pharmacovigilance practices of clozapine use in Eastern European countries (except Russia). Methods: Questionnaires and data from administrative databases (2016 and 2021), package inserts and national guidelines were collected from 16 co-authors from 16 countries (unsuccessful for 5 countries). Reports of clozapine adverse drug reactions (ADRs) sent to the global pharmacovigilance database (VigiBase™) were analyzed from introduction to December 31, 2022. Results: Clozapine prescription among antipsychotics in 2021 varied six-fold across countries, from 2.8% in the Czech Republic to 15.8% in Montenegro. The utilization of antipsychotics in both 2016 and 2021 was highest in Croatia, and lowest in Serbia in 2016, and Montenegro in 2021, which had half the defined daily dose (DDD)/1000/day compared to the Croatian data. From 2016 to 2021, the prevalence of antipsychotic use increased in almost all countries; the proportion of clozapine use mainly remained unchanged. Differences were detected in hematological monitoring requirements and clozapine approved indications. Almost no national schizophrenia guidelines mention clozapine-induced myocarditis or individual titration schemes. The VigiBase search indicated major underreporting regarding clozapine and its fatal outcomes. By comparison, the United Kingdom had less than half the population of these Eastern European countries but reported to VigiBase more clozapine ADRs by 89fold and clozapine fatal outcomes by almost 300-fold. Conclusion: Clozapine is under-utilized in Eastern European countries. Introducing individualized clozapine treatment schedules may help to maximize clozapine benefits and safety. Major improvement is needed in reporting clozapine ADRs and fatal outcomes in Eastern European countries. |
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