Clozapine Prescription Pattern In Patients With Schizophrenia In Asia

Background:As a severe mental illness with global lifetime prevalence close to 1%,schizophrenia has the characteristics of chronic psychiatric condition,poor prognosis,high recurrence rate and disability rate,which is hard to treat and become a public health issue of common concern worldwide.Although there are many methods to treat schizophrenia.the drug treatment is the main way at present.Among those antipsychotic drugs,clozapine is widely used in Asia because of its unique curative effect on treatment refractory schizophrenia.According to previous surveys conducted by the Research on Asian Psychotropic prescription study(REAP),the prescription patterns of clozapine differs from countries and regions.Objectives:This study is based on the fourth Research on Asian Psychotropic prescription study on antipsychotic drug(REAP-AP4),to investigate the clozapine prescription patterns and related influencing factors in schizophrenia patients in Asian countries and regions.Also to evaluate the associated factors of the trends and changes of clozapine use compared with the previous three surveys conducted:in 2001,2004,and 2008.Methods:The REAP-AP4 study was conducted in 2016,including 15 countries and regions in Asia to collect samples of patients diagnosed with schizophrenia from March to May,by using the convenient sampling method and standardized data collection procedure.Patients relevant demographic and clinical information was upload through the cloud system.In this study,SPSS software version 20.0 for Windows was used to analyze the collected and verified data,significance level was set at 0.05,with two-sided test.Descriptive statistics were performed on the patient,s basic data and the clozapine prescription pattern.The appropriate univariate analysis was used to compare sociodemographic and clinical data between the clozapine group and the non-clozapine group.Multiple logistic regression analysis was used to ascertain the correlates of clozapine prescription.Results:Overall,3,744 patients were recruited from 71 hospital psychiatric units on 15 countries and regions in Asia in REAP-AP4.In total,18.4%of the sample received clozapine,ranging from 2.6%in Japan to 32.3%in Hong Kong.Multiple 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.In countries and areas recruited patients by using long version questionnaire,patients received clozapine prescription with a higher dose of antipsychotic drugs(P<0.001),higher score in BPRS(P<0.001)and DIEPSS(P=0.03)scale,more non-drug treatments(P=0.005),more negative symptoms(P<0.001),more weight gain(P=0.001),less FGAs and no-clozapine SGAs(P<0.001).In the four studies from 2001 to 2016,patients receiving clozapine prescriptions showed an overall upward trend,however,the proportions and patterns observed within difrgerent countries and regions at each survey varied considerably.Multiple logistic regression analysis showed that patients taking clozapine had higher doses of antipsychotic drugs(OR=1.002,P<0.001),less frequent first admission(OR=0.4,P<0.001),less use of FGAs(OR=0.1,P<0.001),more serious negative symptoms(OR=1.6,P<0.001),more weight gain(OR=1.3,P=0.03)and fewer extrapyramidal adverse reactions(OR=0.7,P<0.001).Conclusions:Clozapine use remained prevalent in schizophrenia patients in Asia,with an increasing trend and large variation across different countries and territories.Factors other than psychopharmacological principles play an important role,regular surveys on the use of psychotropic medications for schizophrenia patients are important for monitoring pharmacotherapy practice in Asia.