Clozapine, neutropenia and Covid-19 : should clinicians be concerned? 3 months report
© 2021 Published by Elsevier Inc..
BACKGROUND: Clozapine is among the most effective antipsychotics used for treatment resistant schizophrenia. Adverse reactions to clozapine include neutropenia. In March 2020, at the start of the Coronavirus -19 pandemic, clinicians raised concerns regarding continuation of antipsychotic treatment, and specifically of clozapine, in patients with coronavirus disease. We aimed here at providing a short report focusing on the association between neutropenia and clozapine in a case series of psychiatric inpatients diagnosed with COVID-19.
PATIENTS & METHODS: We retrospectively inspected data of 10 patients on clozapine, admitted to Highgate Mental Health Centre, Camden & Islington NHS Foundation Trust, between March and July 2020; selection was based on their COVID-19 positive PCR test. We used a linear regression model to estimate whether there was a significant drop in the neutrophil count during SARS-CoV-2 infection.The analysis was done in R using a linear regression to the origin.
RESULTS: Data were collected on 10 patients, of which 7 were males. During COVID-19 infection, neutrophils' count (ANC) was 4.13 × 109/l (SD = 2.70) which constituted a significant drop from a baseline value of 5.2 × 109/l (SD = 2.24). The mean relative reduction in ANC was -0.2729 (SD = 0.1666). The beta value of 0.8377 obtained with the linear regression showed that ANC values during SARS-CoV-2 infection were 83.77% of the baseline ANC showing that within the two time points there was a decrease of 16.23%. The linear regression had a pvalue = 8.96 × 10-8 and an adjusted R2 of 95.94% which shows that the variability of the data is very well explained by the model. We also compared baseline ANC with ANC values approximately a month after resolution of the infection and results indicate that ANC values return to a 95% of baseline.
CONCLUSIONS: Clinicians should bear in mind that a significant drop in neutrophils' count may occur in patients taking clozapine and affected from a SARS-CoV-2 infectionand that this drop is only transitory.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Brain, behavior, & immunity - health - 13(2021) vom: 27. Mai, Seite 100212 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bonaccorso, Stefania [VerfasserIn] |
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| Links: |
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| Themen: |
Absolute Neutrophil Count (ANC) |
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| Anmerkungen: |
Date Revised 21.04.2022 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.bbih.2021.100212 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM32088094X |
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| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2021 Published by Elsevier Inc. | ||
| 520 | |a BACKGROUND: Clozapine is among the most effective antipsychotics used for treatment resistant schizophrenia. Adverse reactions to clozapine include neutropenia. In March 2020, at the start of the Coronavirus -19 pandemic, clinicians raised concerns regarding continuation of antipsychotic treatment, and specifically of clozapine, in patients with coronavirus disease. We aimed here at providing a short report focusing on the association between neutropenia and clozapine in a case series of psychiatric inpatients diagnosed with COVID-19 | ||
| 520 | |a PATIENTS & METHODS: We retrospectively inspected data of 10 patients on clozapine, admitted to Highgate Mental Health Centre, Camden & Islington NHS Foundation Trust, between March and July 2020; selection was based on their COVID-19 positive PCR test. We used a linear regression model to estimate whether there was a significant drop in the neutrophil count during SARS-CoV-2 infection.The analysis was done in R using a linear regression to the origin | ||
| 520 | |a RESULTS: Data were collected on 10 patients, of which 7 were males. During COVID-19 infection, neutrophils' count (ANC) was 4.13 × 109/l (SD = 2.70) which constituted a significant drop from a baseline value of 5.2 × 109/l (SD = 2.24). The mean relative reduction in ANC was -0.2729 (SD = 0.1666). The beta value of 0.8377 obtained with the linear regression showed that ANC values during SARS-CoV-2 infection were 83.77% of the baseline ANC showing that within the two time points there was a decrease of 16.23%. The linear regression had a pvalue = 8.96 × 10-8 and an adjusted R2 of 95.94% which shows that the variability of the data is very well explained by the model. We also compared baseline ANC with ANC values approximately a month after resolution of the infection and results indicate that ANC values return to a 95% of baseline | ||
| 520 | |a CONCLUSIONS: Clinicians should bear in mind that a significant drop in neutrophils' count may occur in patients taking clozapine and affected from a SARS-CoV-2 infectionand that this drop is only transitory | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Absolute Neutrophil Count (ANC) | |
| 650 | 4 | |a Agranulocytosis | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Clozapine | |
| 650 | 4 | |a Coronavirus | |
| 650 | 4 | |a Lymphopenia | |
| 650 | 4 | |a Neutropenia | |
| 650 | 4 | |a Neutrophilia | |
| 650 | 4 | |a Neutrophils | |
| 650 | 4 | |a Psychosis | |
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 4 | |a Schizophrenia | |
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| 700 | 1 | |a Ouabbou, Sophie |e verfasserin |4 aut | |
| 700 | 1 | |a Theleritis, Christos |e verfasserin |4 aut | |
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| 700 | 1 | |a Schifano, Fabrizio |e verfasserin |4 aut | |
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