| Title: |
Absolute neutrophil count and adverse drug reaction monitoring during clozapine treatment: consensus guidelines from a global Delphi panel |
| Authors: |
Siskind, D; McCutcheon, RA; Northwood, K; Pillinger, T; Chan, S; Correll, CU; Cotes, R; Every-Palmer, S; Hahn, M; Howes, O; Kane, JM; Kelly, DL; Korman, N; Lappin, J; Mena, C; Myles, N; Agid, O; Arango, C; Asmal, L; Ayinde, OO; Baptiste, T; Béchard, L; Bitter, I; Bittner, RA; Breznoscakova, D; Chen, E; Chkonia, E; Citrome, L; Clark, SR; Corbeil, O; Cordoba, R; Crossley, N; de Bartolomeis, A; Ebdrup, BH; Fernandez-Egea, E; Elkis, H; Eltorki, Y; Šimunović, Filipčić I; de Filippis, R; Fleischhacker, W; Freudenreich, O; Gadelha, A; Gama, CS; Gaughran, F; Gee, S; Guinart, D; Hallak, JEC; Harris, A; Hasan, A; Honer, W; Jayaram, M; Kanazawa, T; Kawashima, H; Keating, D; Kim, SH; Kwon, JS; Lane, H; Lee, J; Lennox, B; de Leon, J; Leung, JG; Luykx, JJ; MacCabe, J; Murray, G; Nielsen, J; O'Donoghue, B; Oloyede, E; Qubad, M; Remington, G; Roy, M; Rubio, J; Sagud, M; Schulte, PFJ; Selten, J; Si, T; Smith, L; Sommer, I; Sundram, S; Taipale, H; Takeuchi, H; Tandon, R; Tanzer, T; Taylor, D; Thirthalli, J; Tiihonen, J; Uchida, H; Venkatasubramanian, G; Verdoux, H; Wagner, E; Xin, Y; Yağcıoğlu, AEA; Yung, A |
| Publisher Information: |
Elsevier |
| Publication Year: |
2025 |
| Collection: |
University of Hong Kong: HKU Scholars Hub |
| Description: |
Summary Despite its superior effectiveness for treatment-resistant schizophrenia, clozapine has a high burden of adverse drug reactions (ADRs), which require monitoring and treatment. This global Delphi study has established consensus guidelines for absolute neutrophil count (ANC) thresholds for consideration of clozapine cessation and provided monitoring protocols for ADR management. Recommendations include lowering ANC cessation thresholds to 1·0 × 109 cells per L (0·5 × 109 cells per L for Duffy antigen receptor for chemokines-null individuals) and discontinuing routine ANC monitoring after 2 years. Comprehensive ADR monitoring every 3 months should address the metabolic syndrome, constipation, gastro-oesophageal reflux, sialorrhea, nocturnal enuresis, tachycardia, sleep apnoea, sedation, and other ADRs. Consumer representatives underscored the need for shared decision-making, streamlined monitoring, and accessible patient education. Although barriers persist, these findings support updating global policies to reduce burden on patients, enhance adherence, and optimise clinical outcomes. Incorporating evidence-based guidelines into practice could transform clozapine care, balancing safety with practicality to improve the lives of those with treatment-resistant schizophrenia. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
The Lancet Psychiatry; The Lancet Psychiatry, 2025; https://hub.hku.hk/handle/10722/357804 |
| DOI: |
10.1016/S2215-0366(25)00098-7 |
| Availability: |
https://hub.hku.hk/handle/10722/357804; https://doi.org/10.1016/S2215-0366(25)00098-7 |
| Rights: |
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. |
| Accession Number: |
edsbas.543F9DAD |
| Database: |
BASE |