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Psychiatry Res. 2019 Mar 15. pii: S0165-1781(18)32218-2. doi: 10.1016/j.psychres.2019.02.056. [Epub ahead of print]

Clozapine prescription pattern in patients with schizophrenia in Asia: The REAP survey (2016).

Author information

1
Department of Psychiatry and Psychology, Southern Medical University Nanfang Hospital, Guangdong, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou, China.
2
Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Avenida da Universidade, Taipa, Macao SAR, China.
3
The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China.
4
Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan.
5
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
6
Institute of Mental Health, Buangkok Green Medical Park, Singapore.
7
Department of Psychiatric Epidemiology, Shanghai Mental Health Center, Shanghai, China.
8
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
9
Association for the Improvement of Mental Health Programmes, Geneva, Switzerland.
10
Department of Pharmacology, National University of Singapore, Singapore.
11
Chiayi Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Chiayi, Taiwan.
12
International Center for Medical Research, Kobe University School of Medicine, Kobe, Japan.
13
Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan.
14
Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.
15
University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia.
16
Mintoharjo Hospital, Jakarta, Indonesia.
17
Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India.
18
Department of Psychiatry & Mental Health, Hospital Tuanku Fauziah, Kangar, Perlis, Malaysia.
19
Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan.
20
Department of Psychiatry, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
21
Department of Mental Health, University of Medicine, Magway, Myanmar.
22
Department of Psychiatry and Psychology, Southern Medical University Nanfang Hospital, Guangdong, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou, China. Electronic address: zhang73bin@hotmail.com.
23
Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Avenida da Universidade, Taipa, Macao SAR, China. Electronic address: xyutly@gmail.com.

Abstract

Clozapine is an effective antipsychotic medication for treatment resistant schizophrenia and is widely used in Asian countries. This study investigated clozapine prescription patterns and their associated factors in Asian countries and territories based on the database of the Research on Asian Psychotropic prescription study (REAP) conducted in 2016. Demographic and clinical information of 3744 schizophrenia patients in 15 Asian countries and territories was collected with a standardized data collection form. In total, 18.4% of the sample received clozapine, ranging from 2.6% in Japan to 32.3% in Hong Kong. Binary logistic regression analysis revealed that higher antipsychotic dose (OR = 1.002, P < 0.001), less frequent first admission in the sample (OR = 0.6, P < 0.001), more severe negative symptoms (OR = 1.4, P = 0.001) and less first generation antipsychotics (FGAs) (OR = 0.2, P < 0.001) were independently and significantly associated with clozapine prescription. Clozapine is frequently and increasingly prescribed for schizophrenia in Asia, with large variation across countries and territories. Given the diverse prescription patterns of clozapine found in Asian countries/territories, the clinical rationale of clozapine prescription needs careful consideration in Asia with more local input.

KEYWORDS:

Asia; Clozapine; Prescription patterns; Schizophrenia

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