Kırpınar M. M., Aksoy Poyraz C., Yıldırım İ., Polat C. D., Çakmak K., Usta Sağlam N. G., ...Daha Fazla
SCHIZOPHRENIA RESEARCH, cilt.293, ss.8-16, 2026 (SCI-Expanded, SSCI, Scopus)
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Yayın Türü:
Makale / Tam Makale
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Cilt numarası:
293
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Basım Tarihi:
2026
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Doi Numarası:
10.1016/j.schres.2026.03.012
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Dergi Adı:
SCHIZOPHRENIA RESEARCH
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Derginin Tarandığı İndeksler:
Scopus, Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), BIOSIS, CINAHL, Educational research abstracts (ERA), EMBASE, MEDLINE, Psycinfo, Public Affairs Index
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Sayfa Sayıları:
ss.8-16
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İstanbul Üniversitesi-Cerrahpaşa Adresli:
Evet
Özet
Background
Clozapine is the most effective treatment for treatment-resistant schizophrenia, however early discontinuation remains common, preventing a substantial proportion of patients from achieving its full therapeutic benefit. Evidence regarding predictors of early clozapine discontinuation under rapid titration in inpatient settings is limited.
Methods
We conducted a retrospective cohort study of 180 psychiatric inpatients who initiated clozapine, identified through screening of 3343 individuals hospitalised at a tertiary care hospital in Turkey between 2016 and 2025. Early discontinuation was defined as cessation within 90 days. Demographic and clinical variables, inpatient titration characteristics, and clozapine-related adverse effects were extracted from electronic medical records. Time to discontinuation was analyzed using Kaplan–Meier survival curves and Cox proportional hazards models.
Results
Within 90 days, 46 patients (25.5%) discontinued clozapine. Female sex (HR = 2.88, 95% CI 1.51–5.47, p = 0.001) and increasing age independently predicted a higher risk of discontinuation. Diagnosis, smoking, and valproate use were not associated with discontinuation. Clozapine-associated myocarditis occurred in 3.88% of the cohort, and when combined with transaminase elevations, inflammatory adverse events accounted for 7.2% of early discontinuations. These events clustered during early treatment phase under rapid inpatient titration, whereas most non-inflammatory adverse effects were manageable with monitoring and dose adjustment.
Conclusions
Nearly one-quarter of patients discontinued clozapine within the first 90 days. Female sex and older age were key predictors of early cessation. The observed incidence of inflammatory adverse events during rapid inpatient titration underscores the importance of cautious, individualized titration strategies—particularly in patients at increased risk of early intolerance.