Clozapine and mortality: A comparison with other antipsychotics in a nationwide Danish cohort study
Research output: Contribution to journal › Journal article › Research › peer-review
Standard
Clozapine and mortality: A comparison with other antipsychotics in a nationwide Danish cohort study. / Zalm, Yvonne; Foldager, Leslie; Termorshuizen, Fabian; Sommer, Iris E.; Nielsen, Jimmi; Selten, Jean‐paul.
In: Acta Psychiatrica Scandinavica, Vol. 143, No. 3, 2021, p. 216-226.Research output: Contribution to journal › Journal article › Research › peer-review
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Clozapine and mortality: A comparison with other antipsychotics in a nationwide Danish cohort study
AU - Zalm, Yvonne
AU - Foldager, Leslie
AU - Termorshuizen, Fabian
AU - Sommer, Iris E.
AU - Nielsen, Jimmi
AU - Selten, Jean‐paul
PY - 2021
Y1 - 2021
N2 - ObjectiveTo compare the mortality in people using clozapine to that of people using other antipsychotics.MethodsDanish incidence cohort of 22,110 patients with a first diagnosis of non-affective psychotic disorder (1995–2013) and a prevalence cohort of 50,881 patients ever diagnosed with such a disorder (1969–2013). Hazard ratios (HR) were calculated for the antipsychotic drug used at the time of death (“current use”: incidence and prevalence cohort) and for the drug used for the longest at that moment (“cumulative use”: incidence cohort), using a Cox model with adjustment for somatic comorbidity. Clozapine was the reference drug.ResultsAs for current drug use, the risk of suicide was higher among users of other antipsychotics in the incidence (HRadj = 1.76; 95% CI 0.72–4.32) and prevalence (HRadj = 2.20; 95% CI 1.35–3.59) cohorts. There was no significant difference in all-cause or cardiovascular mortality in the two cohorts. Cumulative use of clozapine was not associated with an increased cardiovascular mortality. Cumulative use of other antipsychotics for up to 1 year was associated with a lower all-cause mortality and suicide risk than a similar period of clozapine use (all-cause: HRadj = 0.73; 95% CI 0.63–0.85, suicide; HRadj = 0.65; 95% CI 0.46–0.91).ConclusionThe results indicate that the use of clozapine is not associated with increased cardiovascular mortality. We found opposing trends toward a lower risk of suicide during current use of clozapine and a higher risk of suicide associated with cumulative use up to 1 year. This suggests that clozapine cessation marks a period of high risk of suicide.
AB - ObjectiveTo compare the mortality in people using clozapine to that of people using other antipsychotics.MethodsDanish incidence cohort of 22,110 patients with a first diagnosis of non-affective psychotic disorder (1995–2013) and a prevalence cohort of 50,881 patients ever diagnosed with such a disorder (1969–2013). Hazard ratios (HR) were calculated for the antipsychotic drug used at the time of death (“current use”: incidence and prevalence cohort) and for the drug used for the longest at that moment (“cumulative use”: incidence cohort), using a Cox model with adjustment for somatic comorbidity. Clozapine was the reference drug.ResultsAs for current drug use, the risk of suicide was higher among users of other antipsychotics in the incidence (HRadj = 1.76; 95% CI 0.72–4.32) and prevalence (HRadj = 2.20; 95% CI 1.35–3.59) cohorts. There was no significant difference in all-cause or cardiovascular mortality in the two cohorts. Cumulative use of clozapine was not associated with an increased cardiovascular mortality. Cumulative use of other antipsychotics for up to 1 year was associated with a lower all-cause mortality and suicide risk than a similar period of clozapine use (all-cause: HRadj = 0.73; 95% CI 0.63–0.85, suicide; HRadj = 0.65; 95% CI 0.46–0.91).ConclusionThe results indicate that the use of clozapine is not associated with increased cardiovascular mortality. We found opposing trends toward a lower risk of suicide during current use of clozapine and a higher risk of suicide associated with cumulative use up to 1 year. This suggests that clozapine cessation marks a period of high risk of suicide.
U2 - 10.1111/acps.13267
DO - 10.1111/acps.13267
M3 - Journal article
C2 - 33306211
VL - 143
SP - 216
EP - 226
JO - Acta Psychiatrica Scandinavica. Supplementum
JF - Acta Psychiatrica Scandinavica. Supplementum
SN - 0065-1591
IS - 3
ER -
ID: 269596071