Effectiveness of Clozapine Compared to Nonclozapine Antipsychotics in Older Adults With Schizophrenia in Brazil in a 16-Year Follow-Up

Abstract

Objective

To assess the survival of older patients with schizophrenia using clozapine, compared with other atypical antipsychotics (AAPs) provided by the Brazilian National Health System, in a 16-year follow-up.

Design, Setting, Participants

This is an open retrospective cohort study based on administrative data records, with 83,284 patients aged 60 years and older, diagnosed with schizophrenia and to whom AAPs were dispensed between 2000 and 2014.

Measurements

The Kaplan–Meier method was used to estimate the cumulative probability of survival and the Cox proportional hazards model was adjusted to assess the risk factors via the hazard ratio (HR).

Result

Overall survival was 18.0% after a 16-year follow-up, with half the patients dying within 6.2 years. Risk factors for death were being male, residing in Southeastern Brazil, having a history of hospitalization for pneumonia, and using quetiapine. Prescribing clozapine to older adults with schizophrenia was associated with a lower risk of death when compared to nonclozapine AAPs.

Conclusion

This study is one of the few published in the current literature that evaluates survival in older individuals with schizophrenia who use atypical antipsychotics. Clozapine had a protective effect on death when compared to other nonclozapine AAPs.