TY - JOUR
T1 - An expert review of clozapine in Eastern European countries
T2 - Use, regulations and pharmacovigilance
AU - Sagud, Marina
AU - Breznoscakova, Dagmar
AU - Celofiga, Andreja
AU - Chihai, Jana
AU - Chkonia, Eka
AU - Ristic Ignjatovic, Dragana
AU - Injac Stevovic, Lidija
AU - Kopecek, Miloslav
AU - Kurvits, Katrin
AU - Kuzo, Nazar
AU - Lazáry, Judit
AU - Mazaliauskienė, Ramunė
AU - Mladina Perisa, Djurdjica
AU - Novotni, Antoni
AU - Panov, Georgi
AU - Pikirenia, Uladzimir
AU - Rădulescu, Flavian Ștefan
AU - Sukiasyan, Samvel Grant
AU - Taube, Māris
AU - Tomori, Sonila
AU - Wilkowska, Alina
AU - De las Cuevas, Carlos
AU - Sanz, Emilio J.
AU - de Leon, Jose
N1 - Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2024/6
Y1 - 2024/6
N2 - Objectives: To compare the prevalence, regulations, and pharmacovigilance practices of clozapine use in Eastern European countries (except Russia). Methods: Questionnaires and data from administrative databases (2016 and 2021), package inserts and national guidelines were collected from 21 co-authors from 21 countries. Reports of clozapine adverse drug reactions (ADRs) sent to the global pharmacovigilance database (VigiBase™) were analyzed from introduction to December 31, 2022. Results: Clozapine prescription among antipsychotics in 2021 varied six-fold across countries, from 2.8 % in the Czech Republic to 15.8 % in Montenegro. The utilization of antipsychotics in both 2016 and 2021 was highest in Croatia, and lowest in Serbia in 2016, and Montenegro in 2021, which had half the defined daily dose (DDD)/1000/day compared to the Croatian data. From 2016 to 2021, the prevalence of antipsychotic use increased in almost all countries; the proportion of clozapine use mainly remained unchanged. Differences were detected in hematological monitoring requirements and clozapine approved indications. Only a few national schizophrenia guidelines mention clozapine-induced myocarditis or individual titration schemes. The VigiBase search indicated major underreporting regarding clozapine and its fatal outcomes. By comparison, the United Kingdom had less than half the population of these Eastern European countries but reported to VigiBase more clozapine ADRs by 89-fold and clozapine fatal outcomes by almost 300-fold. Conclusion: Clozapine is under-utilized in Eastern European countries. Introducing individualized clozapine treatment schedules may help to maximize clozapine benefits and safety. Major improvement is needed in reporting clozapine ADRs and fatal outcomes in Eastern European countries.
AB - Objectives: To compare the prevalence, regulations, and pharmacovigilance practices of clozapine use in Eastern European countries (except Russia). Methods: Questionnaires and data from administrative databases (2016 and 2021), package inserts and national guidelines were collected from 21 co-authors from 21 countries. Reports of clozapine adverse drug reactions (ADRs) sent to the global pharmacovigilance database (VigiBase™) were analyzed from introduction to December 31, 2022. Results: Clozapine prescription among antipsychotics in 2021 varied six-fold across countries, from 2.8 % in the Czech Republic to 15.8 % in Montenegro. The utilization of antipsychotics in both 2016 and 2021 was highest in Croatia, and lowest in Serbia in 2016, and Montenegro in 2021, which had half the defined daily dose (DDD)/1000/day compared to the Croatian data. From 2016 to 2021, the prevalence of antipsychotic use increased in almost all countries; the proportion of clozapine use mainly remained unchanged. Differences were detected in hematological monitoring requirements and clozapine approved indications. Only a few national schizophrenia guidelines mention clozapine-induced myocarditis or individual titration schemes. The VigiBase search indicated major underreporting regarding clozapine and its fatal outcomes. By comparison, the United Kingdom had less than half the population of these Eastern European countries but reported to VigiBase more clozapine ADRs by 89-fold and clozapine fatal outcomes by almost 300-fold. Conclusion: Clozapine is under-utilized in Eastern European countries. Introducing individualized clozapine treatment schedules may help to maximize clozapine benefits and safety. Major improvement is needed in reporting clozapine ADRs and fatal outcomes in Eastern European countries.
KW - Clozapine/administration and dosage
KW - Clozapine/adverse effects
KW - Clozapine/therapeutic use
KW - Drug labeling
KW - Europe, Eastern
KW - Schizophrenia
UR - http://www.scopus.com/inward/record.url?scp=85173064116&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85173064116&partnerID=8YFLogxK
U2 - 10.1016/j.schres.2023.09.002
DO - 10.1016/j.schres.2023.09.002
M3 - Article
C2 - 37783650
AN - SCOPUS:85173064116
SN - 0920-9964
VL - 268
SP - 53
EP - 59
JO - Schizophrenia Research
JF - Schizophrenia Research
ER -