When, Why and How to Re-challenge Clozapine in Schizophrenia Following Myocarditis.

IF 7.4 2区 医学 Q1 CLINICAL NEUROLOGY CNS drugs Pub Date : 2024-09-01 Epub Date: 2024-07-01 DOI:10.1007/s40263-024-01100-4
Mishal Qubad, Gabriele Dupont, Martina Hahn, Simon S Martin, Valentina Puntmann, Eike Nagel, Andreas Reif, Robert A Bittner
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Abstract

Clozapine-induced myocarditis (CIM) is among the most important adverse events limiting the use of clozapine as the most effective treatment for schizophrenia. CIM necessitates the immediate termination of clozapine, often resulting in its permanent discontinuation with considerable detrimental effects on patients' psychopathology and long-term outcome. Consequently, a clozapine re-challenge after CIM is increasingly regarded as a viable alternative, with published reports indicating a success rate of approximately 60%. However, published cases of re-challenges after CIM remain limited. Here, we provide a narrative review of the current state of research regarding the epidemiology, pathophysiology, risk factors, diagnosis and clinical management of CIM as well as a synthesis of current recommendations for re-challenging patients after CIM. This includes a step-by-step guide for this crucial procedure based on the current evidence regarding the pathophysiology and risk factors for CIM. Slow dose titration regimes and addressing risk factors including concomitant valproate and olanzapine are crucial both to prevent CIM and to ensure a safe and successful re-challenge. Furthermore, we discuss the utility of C-reactive protein, troponin, N-terminal-pro hormone and brain natriuretic peptide, therapeutic drug-monitoring and cardiac magnetic resonance imaging for CIM screening and diagnosis as well as for post-CIM re-challenges.

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患有心肌炎的精神分裂症患者何时、为何以及如何再次使用氯氮平?
氯氮平诱发的心肌炎(CIM)是限制氯氮平作为精神分裂症最有效治疗药物使用的最重要不良反应之一。氯氮平诱发的心肌炎需要立即停用氯氮平,通常会导致永久性停药,对患者的精神病理学和长期疗效产生相当大的不利影响。因此,越来越多的人认为在 CIM 后重新使用氯氮平是一种可行的替代方法,已发表的报告显示成功率约为 60%。然而,已发表的 CIM 后再次用药的病例仍然有限。在此,我们对有关 CIM 的流行病学、病理生理学、风险因素、诊断和临床管理的研究现状进行了叙述性综述,并对目前有关 CIM 后重新挑战患者的建议进行了总结。其中包括根据目前有关 CIM 病理生理学和风险因素的证据,为这一关键程序提供分步指南。缓慢的剂量滴定方案以及应对包括同时服用丙戊酸钠和奥氮平在内的风险因素,对于预防 CIM 和确保安全、成功的再挑战至关重要。此外,我们还讨论了 C 反应蛋白、肌钙蛋白、N-末端丙种球蛋白、脑钠肽、治疗药物监测和心脏磁共振成像在 CIM 筛查和诊断以及 CIM 后再挑战中的作用。
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来源期刊
CNS drugs
CNS drugs 医学-精神病学
CiteScore
12.00
自引率
3.30%
发文量
82
审稿时长
6-12 weeks
期刊介绍: CNS Drugs promotes rational pharmacotherapy within the disciplines of clinical psychiatry and neurology. The Journal includes: - Overviews of contentious or emerging issues. - Comprehensive narrative reviews that provide an authoritative source of information on pharmacological approaches to managing neurological and psychiatric illnesses. - Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. - Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in neurology and psychiatry. - Original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in CNS Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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