The Pharmaceutical Journal
Vol 270 No 7232 p72
18 January 2003

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Journal of Clinical Psychiatry (www.psychiatrist.com)

Use of best therapy for treatment resistant schizophrenia delayed

Use of clozapine (Clozaril) in treatment-resistant schizophrenia is probably delayed for longer than is clinically desirable, results of a case note review by pharmacists have suggested.

David Taylor, chief pharmacist at the Maudsley Hospital, London, and colleagues examined the prescribing histories of 112 patients treated with clozapine in four south London hospitals. For each patient they calculated the time between first use of clozapine and the time at which the patient might first have been considered to be resistant to treatment. "Clozapine was delayed, on average, for up to five years," they say.

The researchers concede that the data do not show unequivocally that clozapine treatment was unnecessarily or inappropriately delayed. However, they say that the high rates of antipsychotic co-prescription before use of clozapine, and the high number of episodes of antipsychotic use and of different drugs used is evidence that clozapine was used later than was desirable.

Mr Taylor told The Journal: "Clozapine is clearly the only treatment likely to be effective in refractory schizophrenia yet, as this study shows, its use is delayed while a succession of other drugs are prescribed, often in combination. Many prescribers have concerns about clozapine's toxicity and tolerability but it seems unsupportable to prescribe instead other apparently better tolerated drugs which have little or no chance of being effective."

The study, funded by Novartis, is published in the Journal of Clinical Psychiatry (2003;64:30).