4.5 Article

COVID-related hospitalization, intensive care treatment, and all-cause mortality in patients with psychosis and treated with clozapine

Journal

EUROPEAN NEUROPSYCHOPHARMACOLOGY
Volume 56, Issue -, Pages 92-99

Publisher

ELSEVIER
DOI: 10.1016/j.euroneuro.2022.01.007

Keywords

Antipsychotic agents; Clozapine; COVID-19; SARS-CoV-2; Schizophrenia

Funding

  1. Clinical Records Interactive Search (CRIS) system - National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London
  2. joint infrastructure grant from Guy's and St Thomas' Charity and the Maudsley Charity [BRC-2011-10035]

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This study investigated the association between clozapine treatment and increased risk of adverse outcomes in COVID-19 among patients with schizophrenia-spectrum disorders. The results showed that there was no significant association between clozapine treatment and hospitalization, intensive care treatment, or death during COVID-19 infection.
Clozapine, an antipsychotic, is associated with increased susceptibility to infection with COVID19, compared to other antipsychotics. Here, we investigate associations between clozapine treatment and increased risk of adverse outcomes of COVID-19, namely COVID-related hospitalisation, intensive care treatment, and death, amongst patients taking antipsychotics with schizophrenia-spectrum disorders. Using the clinical records of South London and Maudsley NHS Foundation Trust, we identified 157 individuals who had an ICD-10 diagnosis of schizophrenia spectrum disorders, were taking antipsychotics (clozapine or other antipsychotics) at the time of COVID-19 pandemic in the UK and had a laboratory-confirmed COVID-19 infection. The following health outcomes were measured: COVID-related hospitalisation, COVID-related intensive care treatment and death. We tested associations between clozapine treatment and each outcome using logistic regression models, adjusting for gender, age, ethnicity, neighbourhood deprivation, obesity, smoking status, diabetes, asthma, bronchitis and hypertension using propensity scores. Of the 157 individuals who developed COVID-19 while on antipsychotics (clozapine or other antipsychotics), there were 28% COVID-related hospitalisations, 8% COVIDrelated intensive care treatments and 8% deaths of any cause during the 28 days follow-up period. amongst those taking clozapine, there were 25% COVID-related hospitalisations, 7% COVID-related intensive care treatments and 7% deaths. In both unadjusted and adjusted analyses, we found no significant association between clozapine and any of the outcomes. Thus, we found no evidence that patients with clozapine treatment at time of COVID-19 infection had increased risk of hospitalisation, intensive care treatment or death, compared to non-clozapine antipsychotic-treated patients. However, further research should be considered in larger samples to confirm this. (c) 2022 Published by Elsevier B.V.

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