An expert review of clozapine in Eastern European countries: Use, regulations and pharmacovigilance

Marina Sagud, Dagmar Breznoscakova, Andreja Celofiga, Jana Chihai, Eka Chkonia, Dragana Ristic Ignjatovic, Lidija Injac Stevovic, Miloslav Kopecek, Katrin Kurvits, Nazar Kuzo, Judit Lazáry, Ramunė Mazaliauskienė, Djurdjica Mladina Perisa, Antoni Novotni, Georgi Panov, Uladzimir Pikirenia, Flavian Ștefan Rădulescu, Samvel Grant Sukiasyan, Māris Taube, Sonila TomoriAlina Wilkowska, Carlos De las Cuevas, Emilio J. Sanz, Jose de Leon

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)53-59
Number of pages7
JournalSchizophrenia Research
Volume268
DOIs
StatePublished - Jun 2024

Bibliographical note

Publisher Copyright:
© 2023 Elsevier B.V.

Keywords

  • Clozapine/administration and dosage
  • Clozapine/adverse effects
  • Clozapine/therapeutic use
  • Drug labeling
  • Europe, Eastern
  • Schizophrenia

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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