Clozapine prescribing and safety during COVID-19

Abstract

Schizophrenia is a chronic mental disorder affecting 20 million people worldwide (James et al., 2018). Clozapine remains the most effective pharmacological treatment for schizophrenia but requires regular blood monitoring due to its propensity to cause agranulocytosis. The Coronavirus disease 2019 (COVID-19) begot unprecedented restrictions on provision of psychiatric services and precautionary measures stood as major obstacles to healthcare access (Grover et al., 2020). An expert subgroup of the Treatment Response and Resistance in Psychosis Working Group (TRRPG) developed recommendations to face COVID-related challenges, including the dispensation of medication for up to 90 days and reducing the frequency of Absolute Neutrophil Count (ANC) testing to once every 3 months for patients who had been on clozapine for more than one year with no previous record of neutropenia (Siskind et al., 2020). We aimed to evaluate the trend of clozapine prescriptions during the COVID-19 pandemic in Qatar. Our secondary objectives were to evaluate the rate of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection among patients on clozapine; rates of neutropenia and related medical complications; clozapine toxicity; psychiatric and medical admissions during this period and whether these variables were associated with revised clozapine dispensation and blood monitoring.