Population-based study of long-term mortality risk associated with clozapine use among patients with schizophrenia

作者：Huiquan Zhou, Hao Luo, Jennifer Tang, William G. Honer, Tarun Bastiampillai, Jiayi Zhou, Heidi Taipale, Wing Chung Chang, Simon S. Y. Lui, Edwin Lee, Sherry Kit Wa Chan · 发表于：The British Journal of Psychiatry · 年份：2025 · DOI：10.1192/bjp.2025.10312 · 被引用次数：5 · 研究领域：Schizophrenia research and treatment、Psychopathy, Forensic Psychiatry, Sexual Offending、Healthcare Decision-Making and Restraints

BACKGROUND: Patients with schizophrenia have a significantly elevated risk of mortality. Clozapine is effective for treatment-resistant schizophrenia, but its use is limited by side-effects. Understanding its association with mortality risk is crucial. AIMS: To investigate the associations of clozapine with all-cause and cause-specific mortality risk in schizophrenia patients. METHOD: In this 18-year population-based cohort study, we retrieved electronic health records of schizophrenia patients from all public hospitals in Hong Kong. Clozapine users (ClozUs) comprised schizophrenia patients who initiated clozapine treatment between 2003 and 2012, with the index date set at clozapine initiation. Comparators were non-clozapine antipsychotic users (Non-ClozUs) with the same diagnosis who had never received a clozapine prescription. They were 1:2 propensity score matched with demographic characteristics and physical and psychiatric comorbidities. ClozUs were further defined according to continuation of clozapine use and co-prescription of other antipsychotics (polypharmacy). Accelerated failure time (AFT) models were used to estimate the risk of all-cause and cause-specific mortality (i.e. suicide, cardiovascular disease, infection and cancer). RESULTS: This study included 9,456 individuals (mean (s.d.) age at the index date: 39.13 (12.92) years; 50.73% females; median (interquartile range) follow-up time: 12.37 (9.78-15.22) years), with 2020 continuous ClozUs, 1132 discontinuous...