Clozapine underutilization and discontinuation in African Americans due to leucopenia
Clozapine underutilization and discontinuation in African Americans due to leucopenia
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DOI：
10.1093/schbul/sbl068
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发表时间：
2007-09-01
影响因子：
6.6
通讯作者：
Conley, Robert R.
中科院分区：
文献类型：
--
作者：
Kelly, Deanna L.;Kreyenbuhl, Julie;Conley, Robert R.
非裔美国人氯氮平的使用明显低于白种人。有人认为，非裔美国人的白细胞（WBC）计数较低，被称为良性种族中性粒细胞减少症，可能是造成这种差异的部分原因。我们检查了1875名在马里兰州接受治疗的精神分裂症患者的白细胞减少率和粒细胞缺乏症作为停药原因的发生率。1989年至1999年间，5.3%（311588）的非裔美国人和2.4%（31/1287）的白种人因白细胞减少而停止氯氮平治疗（卡方= 10.35,df = 1, P = 0.001）。无非裔美国人出现粒细胞缺乏症，而8名白种人（0.62%）出现血液异常。在整个治疗过程中，由于白细胞减少而中断治疗。无粒细胞缺乏症导致的停药主要发生在前18周（7/8；87.5%的无粒细胞缺乏症患者）。非裔美国人可能由于良性的种族中性粒细胞减少症而不必要地停用氯氮平。我们同意最近的建议，即承认非裔美国人白细胞值的差异，修改处方指南或像其他国家一样正式承认良性少数民族白细胞减少，以促进这些患者更多地使用氯氮平。
Clozapine use has been notably lower in African American patients than in Caucasians. It has been suggested that lower normal ranges for white blood cell (WBC) counts in African Americans, known as benign ethnic neutropenia, may account partially for the disparity. We examined the rates of leucopenia and agranulocytosis as reasons for discontinuation of clozapine in a sample of 1875 patients with schizophrenia treated in the State of Maryland. Between 1989 and 1999, 5.3% (311588) of African Americans and 2.4% (31/1287) of Caucasians discontinued clozapine treatment due to leucopenia (chi square = 10.35, df = 1, P = 0.001). No African American patients developed agranulocytosis while 8 Caucasian patients (0.62%) developed this blood dyscrasia. Discontinuations due to leucopenia occurred throughout treatment. Discontinuations due to agramilocytosis occurred primarily in the first 18 weeks (7/8; 87.5% patients with agranulocytosis). It is likely that African Americans had clozapine discontinued unnecessarily due to benign ethnic neutropenia. We concur with recent recommendations to acknowledge differences in WBC values in African Americans and to modify prescribing guidelines or formally acknowledge benign ethnic leucopenia like in other countries in order to facilitate greater use of clozapine in these patients.