Journal
SCHIZOPHRENIA BULLETIN
Volume 49, Issue 1, Pages 53-67Publisher
OXFORD UNIV PRESS
DOI: 10.1093/schbul/sbac148
Keywords
COVID-19; coronavirus; clozapine; schizophrenia
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This review found no compelling evidence that the immune system of clozapine users puts them at risk of COVID-19 and further complications. However, evidence of drug-infection interactions highlights the importance of adhering to consensus guidelines on clozapine therapy during the pandemic. Longitudinal studies are needed to examine the longer-term effects of COVID-19 and vaccination in this vulnerable population.
Background/Objectives: There have been concerns that clozapine treatment may undermine the capacity of the body to fight infection and increase the vulnerability to contracting COVID-19. This review of recent cohort studies investigated (1) whether people with a severe psychiatric disorder are at increased risk of COVID-19 and complications, (2) the immunological response of clozapine-users who contract COVID-19, and (3) patients' perspectives on COVID-19 and the pandemic response. Methods: A systematic search of EMBASE, Medline, Pubmed, and PsycINFO databases using PRISMA guidelines using COVID-19, clozapine, and vaccination terms. Results: 18 studies (out of 330 identified) met all criteria (N = 119 054 including 8045 on clozapine). There was no strong evidence that clozapine users may be at increased risk of contracting COVID-19 or developing complications after adjusting for medical comorbidities. Hematological studies showed temporary reductions in neutrophils in COVID-19-positive patients and vaccination suggesting a clozapine effect in defence against infection. Vaccination studies did not report major adverse effects. Increased plasma levels of clozapine and neutropenia however point to COVID-19-related interference of clozapine metabolism. Patient surveys reported limited impact on mental health and positive attitudes regarding pandemic response. Conclusion: This review did not find compelling evidence that the immune system of clozapine users put them at risk of COVID-19 and further complications. Evidence of drug-infection interactions however points to the importance of adhering to consensus guidelines about clozapine therapy during the pandemic. More evidence using longitudinal designs is required to examine the longer-term effects of COVID-19 and vaccination in this vulnerable population.
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