Purpose: An association between antibody deficiency and clozapine use in individuals with Schizophrenia has recently been reported. We hypothesized that if clozapine-associated hypogammaglobulinaemia was clinically relevant this would manifest in referral patterns. Methods: Retrospective case note review of patients referred and assessed by Immunology Centre for Wales (ICW) between January 2005 and July 2018 with extraction of clinical and immunologic features for individuals with diagnosis of schizophrenia-like illness. Results: 1791 adult patients were assessed at ICW during this period; 23 patients had a psychiatric diagnosis of schizophrenia or schizo-affective disorder. Principal indications for referral were findings of low calculated globulin and immunoglobulins. Clozapine was the single most commonly prescribed antipsychotic (17/23), disproportionately increased relative to reported use in the general schizophrenia population (OR 6.48, 95% CI: 1.79 to 23.5). Clozapine therapy was noted in 6/7 (86%) of patients subsequently requiring immunoglobulin replacement therapy (IgRT). Marked reduction of class-switched memory B-cells (CSMB) and plasmablasts were observed in clozapine-treated individuals relative to healthy age-matched controls. Clozapine duration is associated with CSMB decline. One patient discontinued clozapine, with gradual recovery of IgG levels without use of IgRT. Conclusion: Our findings are consistent with enrichment of clozapine-treatment within schizophrenic individuals referred for ICW assessment over the last 13 years. These individuals displayed clinical patterns closely resembling the primary immunodeficiency CVID, however appears reversible upon drug cessation. This has diagnostic, monitoring and treatment implications for psychiatry and immunology teams and directs prospective studies to address causality and the wider implications for this patient group.

中文翻译：

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推荐给全国免疫缺陷诊所的氯氮平治疗的精神分裂症患者的临床和实验室特征显示出类似于CVID的B细胞特征。

目的：最近报道了精神分裂症患者抗体缺乏与氯氮平使用之间的关联。我们假设，如果氯氮平相关的低丙种球蛋白血症在临床上具有相关性，那么这将在转诊模式中体现出来。方法：对2005年1月至2018年7月间由威尔士免疫学中心（ICW）转诊和评估的患者进行回顾性病例笔记审查，并提取诊断为精神分裂症样疾病的个体的临床和免疫学特征。结果：在此期间，有1791名成年患者接受了ICW评估。对精神分裂症或精神分裂症有精神病诊断的23例患者。推荐转诊的主要指征是计算出的球蛋白和免疫球蛋白低。氯氮平是最常用的单一抗精神病药（17/23），相对于报告的在一般精神分裂症人群中的使用，比例成比例地增加（OR 6.48，95％CI：1.79至23.5）。在随后需要免疫球蛋白替代疗法（IgRT）的患者中，有6/7（86％）的患者注意到了氯氮平疗法。相对于健康的年龄匹配的对照组，在氯氮平治疗的个体中观察到类转换记忆B细胞（CSMB）和成浆细胞的明显减少。氯氮平持续时间与CSMB下降有关。一名患者停用氯氮平，不使用IgRT即可逐渐恢复IgG水平。结论：我们的发现与过去13年中用于ICW评估的精神分裂症患者中氯氮平治疗的丰富性相符。这些人的临床表现与原发性免疫缺陷CVID非常相似，但是戒烟后似乎是可逆的。这对精神病学和免疫学团队具有诊断，监测和治疗的意义，并指导前瞻性研究以解决因果关系以及对该患者群体的广泛影响。