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Clozapine and mortality: A comparison with other antipsychotics in a nationwide Danish cohort study

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Clozapine and mortality : A comparison with other antipsychotics in a nationwide Danish cohort study. / van der Zalm, Yvonne C.; Foldager, Leslie; Termorshuizen, Fabian et al.

In: Acta Psychiatrica Scandinavica, Vol. 143, No. 3, 03.2021, p. 216-226.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Harvard

van der Zalm, YC, Foldager, L, Termorshuizen, F, Sommer, IE, Nielsen, J & Selten, J-P 2021, 'Clozapine and mortality: A comparison with other antipsychotics in a nationwide Danish cohort study', Acta Psychiatrica Scandinavica, vol. 143, no. 3, pp. 216-226. https://doi.org/10.1111/acps.13267

Author

van der Zalm, Yvonne C. ; Foldager, Leslie ; Termorshuizen, Fabian et al. / Clozapine and mortality : A comparison with other antipsychotics in a nationwide Danish cohort study. In: Acta Psychiatrica Scandinavica. 2021 ; Vol. 143, No. 3. pp. 216-226.

Bibtex

@article{d2344f2482654b07a6251b82583b12dc,

title = "Clozapine and mortality: A comparison with other antipsychotics in a nationwide Danish cohort study",

abstract = "ObjectiveTo compare the mortality in people using clozapine to that of people using other antipsychotics.Methods Danish 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 ({\textquoteleft}current use{\textquoteright}: incidence and prevalence cohort), and for the drug used for the longest at that moment ({\textquoteleft}cumulative use{\textquoteright}: incidence cohort), using a Cox model with adjustment for somatic comorbidity. Clozapine was the reference drug.Results As 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).Conclusion The results indicate that the use of clozapine is not associated with increased cardiovascular mortality. We found opposing trends towards 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.",

keywords = "psychosis, clozapine, mortality, outpatient treatment, psychosis, clozapine, mortality, outpatient treatment",

author = "{van der Zalm}, {Yvonne C.} and Leslie Foldager and Fabian Termorshuizen and Sommer, {Iris E.} and Jimmi Nielsen and Jean-Paul Selten",

note = "https://doi.org/10.1111/acps.13267",

year = "2021",

month = mar,

doi = "10.1111/acps.13267",

language = "English",

volume = "143",

pages = "216--226",

journal = "Acta Psychiatrica Scandinavica",

issn = "0001-690X",

publisher = "Jossey-Bass",

number = "3",

}

RIS

TY - JOUR

T1 - Clozapine and mortality

T2 - A comparison with other antipsychotics in a nationwide Danish cohort study

AU - van der Zalm, Yvonne C.

AU - Foldager, Leslie

AU - Termorshuizen, Fabian

AU - Sommer, Iris E.

AU - Nielsen, Jimmi

AU - Selten, Jean-Paul

N1 - https://doi.org/10.1111/acps.13267

PY - 2021/3

Y1 - 2021/3

N2 - ObjectiveTo compare the mortality in people using clozapine to that of people using other antipsychotics.Methods Danish 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.Results As 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).Conclusion The results indicate that the use of clozapine is not associated with increased cardiovascular mortality. We found opposing trends towards 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.Methods Danish 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.Results As 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).Conclusion The results indicate that the use of clozapine is not associated with increased cardiovascular mortality. We found opposing trends towards 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.

KW - psychosis

KW - clozapine

KW - mortality

KW - outpatient treatment

KW - psychosis

KW - clozapine

KW - mortality

KW - outpatient treatment

UR - http://www.scopus.com/inward/record.url?scp=85098000570&partnerID=8YFLogxK

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

JF - Acta Psychiatrica Scandinavica

SN - 0001-690X

IS - 3

ER -