International trends in clozapine use: a study in 17 countries
Open accessAbstract
OBJECTIVE: There is some evidence that clozapine is significantly underutilised. Also, clozapine use is thought to vary by country, but so far no international study has assessed trends in clozapine prescribing. Therefore, this study aimed to assess clozapine use trends on an international scale, using standardised criteria for data analysis. METHOD: A repeated cross-sectional design was applied to data extracts (2005-2014) from 17 countries worldwide. RESULTS: In 2014, overall clozapine use prevalence was greatest in Finland (189.2/100 000 persons) and in New Zealand (116.3/100 000), and lowest in the Japanese cohort (0.6/100 000), and in the privately insured US cohort (14.0/100 000). From 2005 to 2014, clozapine use increased in almost all studied countries (relative increase: 7.8-197.2%). In most countries, clozapine use was highest in 40-59-year-olds (range: 0.6/100 000 (Japan) to 344.8/100 000 (Finland)). In youths (10-19 years), clozapine use was highest in Finland (24.7/100 000) and in the publicly insured US cohort (15.5/100 000). CONCLUSION: While clozapine use has increased in most studied countries over recent years, clozapine is still underutilised in many countries, with clozapine utilisation patterns differing significantly between countries. Future research should address the implementation of interventions designed to facilitate increased clozapine utilisation.
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The increase in granulocytes in TRS was primarily driven by those with the more severe phenotype.
“Our sub-analysis of TRS, which is associated with a higher number of positive symptoms (Bachmann et al., 2017), found that the increase in granulocytes was primarily driven by those with the more severe phenotype, supporting this hypothesis.”
From DNA methylation meta-analysis reveals cellular alterations in psychosis and markers of treatment-resistant schizophrenia (2021) · cites this paper as Bachmann et al., 2017
The citation is attached to the assertion that TRS is associated with a higher number of positive symptoms; the granulocyte finding is presented as the citing authors’ own sub-analysis. The source paper’s Introduction discusses clozapine as a treatment for TRS, but the passages found do not address positive-symptom counts or that association (searched: positive symptoms in TRS). (LLM, conf=0.76)
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- Authors
- Bachmann, C. J., Aagaard, L., Bernardo, M., Brandt, L., Cartabia, M., Clavenna, A., Coma Fusté, A., Furu, K., Garuoliené, K., Hoffmann, F., Hollingworth, S., Huybrechts, K. F., Kalverdijk, L. J., Kawakami, K., Kieler, H., Kinoshita, T., López, S. C., Machado‐Alba, J. E., Machado‐Duque, M. E., Mahesri, M., Nishtala, P. S., Piovani, D., Reutfors, J., Saastamoinen, L. K., Sato, I., Schuiling‐Veninga, C. C. M., Shyu, Y. ‐., Siskind, D., Skurtveit, S., Verdoux, H., Wang, L. ‐., Zara Yahni, C., Zoëga, H., & Taylor, D.
- Affiliations
- Freelance Researcher Marburg Germany
- Life Science Team Bech‐Bruun Law Firm Copenhagen Denmark
- Centro de Investigación Biomédica en Red de Salud Mental (ES)
- Karolinska University Hospital (SE)
- Mario Negri Institute for Pharmacological Research (IT)
- Pharmacy Department of Barcelona Health Region Catalan Health Service (CatSalut) Barcelona Spain
- Norwegian Institute of Public Health (NO)
- Medicines Reimbursement Department National Health Insurance Fund of the Republic of Lithuania Vilnius Lithuania
- Carl von Ossietzky Universität Oldenburg (DE)
- The University of Queensland (AU)
- Brigham and Women's Hospital (US)
- University Medical Center Groningen (NL)
- Kyoto University (JP)
- Universidad Tecnológica de Pereira (CO)
- University of Otago (NZ)
- Social Insurance Institution (FI)
- University of Groningen (NL)
- Chang Gung University of Science and Technology (TW)
- Université de Bordeaux (FR)
- Department of Child & Adolescent Psychiatry Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine Kaohsiung Taiwan
- Inserm (FR)
- King's College London (GB)
- Corresponding author
- Bachmann, C. J.
- ORCID
- Bachmann, C. J.
- Aagaard, L.
- Bernardo, M.
- Brandt, L.
- Cartabia, M.
- Clavenna, A.
- Furu, K.
- Hoffmann, F.
- Hollingworth, S.
- Huybrechts, K. F.
- Kalverdijk, L. J.
- Kawakami, K.
- Kieler, H.
- Machado‐Alba, J. E.
- Machado‐Duque, M. E.
- Mahesri, M.
- Nishtala, P. S.
- Piovani, D.
- Reutfors, J.
- Saastamoinen, L. K.
- Sato, I.
- Schuiling‐Veninga, C. C. M.
- Shyu, Y.‐C.
- Siskind, D.
- Skurtveit, S.
- Verdoux, H.
- Zoëga, H.
- Taylor, D.
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2017-05-14
- Volume
- 136
- Issue
- 1
- Pages
- 37-51
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- OpenAlex
- W2612895336
- Cited by
- 314
- References
- 83
- Citations by year
- 2026: 39 · 2025: 39 · 2024: 40 · 2023: 42 · 2022: 28 · 2021: 45 · 2020: 29 · 2019: 26 · 2018: 22 · 2017: 2
- FWCI
- 17.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Chang Gung Memorial Hospital, Linkou (CMRPG2A0341, CLRPG2C0024, CRRPG2F0011)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- clozapine, antipsychotic prescribing, cross-national comparison, prescribing trends, youth mental health, schizophrenia treatment
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Clozapine, Cross-Sectional Studies, Drug Utilization, Humans, Middle Aged, Drug Prescriptions, Antipsychotic Agents, Young Adult
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