Overcoming the barriers to identifying and managing treatment-resistant schizophrenia and to improving access to clozapine: A narrative review and recommendation for clinical practice

Clozapine is the only approved antipsychotic for treatment-resistant schizophrenia (TRS). Although a large body of evidence supports its efficacy and favorable risk-benefit ratio in individuals who have failed two or more antipsychotics, clozapine remains underused. However, variations in clozapine...

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Autores: Agid, Ofer, Crespo-Facorro, Benedicto, de Bartolomeis, Andrea, Fagiolini, Andrea, Howes, Oliver D., Seppälä, Niko, Correll, Christoph U.
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Consejo Superior de Investigaciones Científicas (CSIC)
Repositorio:DIGITAL.CSIC. Repositorio Institucional del CSIC
OAI Identifier:oai:digital.csic.es:10261/367835
Acceso en línea:http://hdl.handle.net/10261/367835
https://api.elsevier.com/content/abstract/scopus_id/85190883902
Access Level:acceso abierto
Palabra clave:Treatment-resistant schizophrenia
Antipsychotics
Clozapine
Treatment barriers
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spelling Overcoming the barriers to identifying and managing treatment-resistant schizophrenia and to improving access to clozapine: A narrative review and recommendation for clinical practiceAgid, OferCrespo-Facorro, Benedictode Bartolomeis, AndreaFagiolini, AndreaHowes, Oliver D.Seppälä, NikoCorrell, Christoph U.Treatment-resistant schizophreniaAntipsychoticsClozapineTreatment barriersClozapine is the only approved antipsychotic for treatment-resistant schizophrenia (TRS). Although a large body of evidence supports its efficacy and favorable risk-benefit ratio in individuals who have failed two or more antipsychotics, clozapine remains underused. However, variations in clozapine utilization across geographic and clinical settings suggest that it could be possible to improve its use. In this narrative review and expert opinion, we summarized information available in the literature on the mechanisms of action, effectiveness, and potential adverse events of clozapine. We identified barriers leading to discouragement in clozapine prescription internationally, and we proposed practical solutions to overcome each barrier. One of the main obstacles identified to the use of clozapine is the lack of appropriate training for physicians: we highlighted the need to develop specific professional programs to train clinicians, both practicing and in residency, on the relevance and efficacy of clozapine in TRS treatment, initiation, maintenance, and management of potential adverse events. This approach would facilitate physicians to identify eligible patients and offer clozapine as a treatment option in the early stage of the disease. We also noted that increasing awareness of the benefits of clozapine among healthcare professionals, people with TRS, and their caregivers can help promote the use of clozapine. Educational material, such as leaflets or videos, could be developed and distributed to achieve this goal. The information provided in this article may be useful to improve disease burden and support healthcare professionals, patients, and caregivers navigating the complex pathways to TRS management.This project was realized by EDRA S.p.A. and supported by an unconditional grant from Viatris.Peer reviewedElsevierViatrisAgid, Ofer [0000-0001-6881-8296]de Bartolomeis, Andrea [0000-0002-3188-5652]Fagiolini, Andrea [0000-0001-5827-0853]Correll, Christoph U. [0000-0002-7254-5646]Consejo Superior de Investigaciones Científicas [https://ror.org/02gfc7t72]202420242024info:eu-repo/semantics/articlehttp://purl.org/coar/resource_type/c_6501Publisher's versioninfo:eu-repo/semantics/publishedVersionapplication/pdfhttp://hdl.handle.net/10261/367835https://api.elsevier.com/content/abstract/scopus_id/85190883902reponame:DIGITAL.CSIC. Repositorio Institucional del CSICinstname:Consejo Superior de Investigaciones Científicas (CSIC)Ingléshttps://doi.org/10.1016/j.euroneuro.2024.04.012Síinfo:eu-repo/semantics/openAccessoai:digital.csic.es:10261/3678352026-05-22T06:33:51Z
dc.title.none.fl_str_mv Overcoming the barriers to identifying and managing treatment-resistant schizophrenia and to improving access to clozapine: A narrative review and recommendation for clinical practice
title Overcoming the barriers to identifying and managing treatment-resistant schizophrenia and to improving access to clozapine: A narrative review and recommendation for clinical practice
spellingShingle Overcoming the barriers to identifying and managing treatment-resistant schizophrenia and to improving access to clozapine: A narrative review and recommendation for clinical practice
Agid, Ofer
Treatment-resistant schizophrenia
Antipsychotics
Clozapine
Treatment barriers
title_short Overcoming the barriers to identifying and managing treatment-resistant schizophrenia and to improving access to clozapine: A narrative review and recommendation for clinical practice
title_full Overcoming the barriers to identifying and managing treatment-resistant schizophrenia and to improving access to clozapine: A narrative review and recommendation for clinical practice
title_fullStr Overcoming the barriers to identifying and managing treatment-resistant schizophrenia and to improving access to clozapine: A narrative review and recommendation for clinical practice
title_full_unstemmed Overcoming the barriers to identifying and managing treatment-resistant schizophrenia and to improving access to clozapine: A narrative review and recommendation for clinical practice
title_sort Overcoming the barriers to identifying and managing treatment-resistant schizophrenia and to improving access to clozapine: A narrative review and recommendation for clinical practice
dc.creator.none.fl_str_mv Agid, Ofer
Crespo-Facorro, Benedicto
de Bartolomeis, Andrea
Fagiolini, Andrea
Howes, Oliver D.
Seppälä, Niko
Correll, Christoph U.
author Agid, Ofer
author_facet Agid, Ofer
Crespo-Facorro, Benedicto
de Bartolomeis, Andrea
Fagiolini, Andrea
Howes, Oliver D.
Seppälä, Niko
Correll, Christoph U.
author_role author
author2 Crespo-Facorro, Benedicto
de Bartolomeis, Andrea
Fagiolini, Andrea
Howes, Oliver D.
Seppälä, Niko
Correll, Christoph U.
author2_role author
author
author
author
author
author
dc.contributor.none.fl_str_mv Viatris
Agid, Ofer [0000-0001-6881-8296]
de Bartolomeis, Andrea [0000-0002-3188-5652]
Fagiolini, Andrea [0000-0001-5827-0853]
Correll, Christoph U. [0000-0002-7254-5646]
Consejo Superior de Investigaciones Científicas [https://ror.org/02gfc7t72]
dc.subject.none.fl_str_mv Treatment-resistant schizophrenia
Antipsychotics
Clozapine
Treatment barriers
topic Treatment-resistant schizophrenia
Antipsychotics
Clozapine
Treatment barriers
description Clozapine is the only approved antipsychotic for treatment-resistant schizophrenia (TRS). Although a large body of evidence supports its efficacy and favorable risk-benefit ratio in individuals who have failed two or more antipsychotics, clozapine remains underused. However, variations in clozapine utilization across geographic and clinical settings suggest that it could be possible to improve its use. In this narrative review and expert opinion, we summarized information available in the literature on the mechanisms of action, effectiveness, and potential adverse events of clozapine. We identified barriers leading to discouragement in clozapine prescription internationally, and we proposed practical solutions to overcome each barrier. One of the main obstacles identified to the use of clozapine is the lack of appropriate training for physicians: we highlighted the need to develop specific professional programs to train clinicians, both practicing and in residency, on the relevance and efficacy of clozapine in TRS treatment, initiation, maintenance, and management of potential adverse events. This approach would facilitate physicians to identify eligible patients and offer clozapine as a treatment option in the early stage of the disease. We also noted that increasing awareness of the benefits of clozapine among healthcare professionals, people with TRS, and their caregivers can help promote the use of clozapine. Educational material, such as leaflets or videos, could be developed and distributed to achieve this goal. The information provided in this article may be useful to improve disease burden and support healthcare professionals, patients, and caregivers navigating the complex pathways to TRS management.
publishDate 2024
dc.date.none.fl_str_mv 2024
2024
2024
dc.type.none.fl_str_mv info:eu-repo/semantics/article
http://purl.org/coar/resource_type/c_6501
Publisher's version
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10261/367835
https://api.elsevier.com/content/abstract/scopus_id/85190883902
url http://hdl.handle.net/10261/367835
https://api.elsevier.com/content/abstract/scopus_id/85190883902
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv https://doi.org/10.1016/j.euroneuro.2024.04.012
Sí
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:DIGITAL.CSIC. Repositorio Institucional del CSIC
instname:Consejo Superior de Investigaciones Científicas (CSIC)
instname_str Consejo Superior de Investigaciones Científicas (CSIC)
reponame_str DIGITAL.CSIC. Repositorio Institucional del CSIC
collection DIGITAL.CSIC. Repositorio Institucional del CSIC
repository.name.fl_str_mv
repository.mail.fl_str_mv
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