Journal
JOURNAL OF PSYCHOPHARMACOLOGY
Volume 33, Issue 4, Pages 449-458Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/0269881118817387
Keywords
Clozapine; readmission; atypical antipsychotics; schizophrenia; schizoaffective disorder
Funding
- Clinical Records Interactive Search (CRIS) system - NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London
- Peggy Pollak Fellowship from the Psychiatry Research Trust
- Medical Research Council (MRC) Clinical Research Training Fellowship [MR/L017105/1]
- Roche
- Pfizer
- Lundbeck
- Janssen
- Medical Research Council (MRC) Population Health Scientist Fellowship [MR/J01219X/1]
- EPSRC [EP/N027280/1] Funding Source: UKRI
- MRC [MC_PC_17214, MR/L017105/1, MR/L011794/1, MR/J01219X/1] Funding Source: UKRI
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Background: Insight into the effect of clozapine is limited by a lack of controlling for confounding variables in current research. Our objective was to investigate the association between clozapine prescribed at discharge, following an inpatient episode, and risk of readmission into secondary mental health services in patients with schizophrenia and schizoaffective disorder, controlling extensively for confounding variables. Methods: Clinical records from 3651 patients were analysed in a retrospective observational cohort study. Cox proportional-hazards regression models were used to assess the risk of hospital readmission. A series of sensitivity analyses were also conducted. Propensity score methods were used to address confounding-by-indication. Results: Patients on clozapine (n=202) had a reduced risk of readmission compared with patients on other antipsychotics (adjusted hazard ratio=0.79; 95% confidence interval: 0.64-0.99; p=0.043). Clozapine also had a protective effect on risk of readmission when compared with olanzapine (adjusted hazard ratio 0.76; 95% confidence interval: 0.60-0.96; p=0.021). The effect size remained consistent after adjusting for an array of possible confounders, as well as using propensity scores to address confounding-by-indication. A statistically significant result was also noted in all but two sensitivity analyses. Conclusion: Our findings suggest that clozapine is associated with a reduced risk of readmission into secondary mental health services.
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