Clozapine is the only licensed pharmacotherapy for treatment-resistant schizophrenia. However, response to clozapine is variable. Understanding the demographic and clinical features associated with response to clozapine may be useful for patient stratification for clinical trials or for identifying patients for earlier initiation of clozapine. We systematically reviewed the literature to investigate clinical and demographic factors associated with variation in clozapine response in treatment-resistant patients with schizophrenia spectrum disorders. Subsequently, we performed a random-effects meta-analysis to evaluate differences in duration of illness, age at clozapine initiation, age of illness onset, body weight and years of education between clozapine responders and non-responders. Thirty-one articles were eligible for qualitative review and 17 of these were quantitatively reviewed. Shorter duration of illness, later illness onset, younger age at clozapine initiation, fewer hospitalisations and fewer antipsychotic trials prior to clozapine initiation showed a trend to be significantly associated with a better response to clozapine. Meta-analysis of seven studies, totalling 313 subjects, found that clozapine responders had a significantly shorter duration of illness compared to clozapine non-responders [g = 0.31; 95% confidence interval (CI) 0.06–0.56; p = 0.01]. The results imply that a delay in clozapine treatment may result in a poorer response and that a focus on prompt treatment with clozapine is warranted.

中文翻译：

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与精神分裂症患者对氯氮平反应相关的人口统计学和临床​​变量：系统评价和荟萃分析


氯氮平是唯一获得许可的治疗难治性精神分裂症的药物疗法。然而，对氯氮平的反应是可变的。了解与氯氮平反应相关的人口统计学和临床​​特征可能有助于临床试验的患者分层或识别早期开始使用氯氮平的患者。我们系统地回顾了文献，以调查与精神分裂症谱系疾病难治性患者氯氮平反应变化相关的临床和人口统计学因素。随后，我们进行了随机效应荟萃分析，以评估氯氮平应答者和无应答者之间的病程、开始使用氯氮平的年龄、发病年龄、体重和受教育年限的差异。 31 篇文章有资格进行定性审查，其中 17 篇进行了定量审查。病程较短、发病较晚、开始使用氯氮平时年龄较小、住院次数较少以及开始使用氯氮平之前的抗精神病药物试验较少，这些趋势与对氯氮平的更好反应显着相关。对 7 项研究（总计 313 名受试者）的荟萃分析发现，与氯氮平无反应者相比，氯氮平反应者的病程明显较短。克= 0.31; 95% 置信区间 (CI) 0.06–0.56； p = 0.01]。结果表明，延迟氯氮平治疗可能会导致疗效较差，因此有必要重点关注氯氮平的及时治疗。