Pharmacopsychiatry 2020; 53(06): 273-283
DOI: 10.1055/a-1208-0045
Original Paper

Effects of Smoking Status on Remission and Metabolic and Cognitive Outcomes in Schizophrenia Patients Treated with Clozapine

Elias Wagner
1  Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
,
Tatiana Oviedo-Salcedo
1  Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
,
Nicola Pelzer
1  Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
,
Wolfgang Strube
1  Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
,
Isabel Maurus
1  Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
,
Stefan Gutwinski
2  Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
,
Stefanie Schreiter
2  Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
,
2  Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
,
Carla-Lou Morgenroth
2  Department of Psychiatry and Psychotherapy, Charité Berlin, Berlin, Germany
,
Cynthia Okhuijsen-Pfeifer
3  Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
,
Jurjen J. Luykx
3  Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
4  Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
5  GGNet Mental Health, second opinion outpatient clinic
,
Peter Falkai
1  Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
,
Thomas Schneider-Axmann
1  Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
,
Alkomiet Hasan
1  Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
6  Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
› Author Affiliations

Abstract

Background Even though clozapine is the recommended last-resort antipsychotic, many patients fail to respond and show treatment-refractory psychotic symptoms. Smoking has been suggested as a possible risk factor for poor clozapine response, hampering remission and negatively impacting somatic outcomes.

Methods Our aim was to test whether smoking status is associated with remission rates and other symptomatic and somatic outcomes. We therefore assessed remission rates according to The Remission in Schizophrenia Working Group (RSWG) criteria, and metabolic and cognitive outcomes among patients with schizophrenia-spectrum disorders treated with clozapine for at least 6 months. For analyses, we grouped our cohort into 3 groups according to clozapine treatment duration (6 months, 2 years, 5 years).

Results One hundred five patients were included in our analyses and grouped according to their clozapine treatment duration. In the 6-months analyses, patients who smoked were significantly more likely to be younger of age (p=0.002) despite on average shorter duration of clozapine treatment (p=0.041) and significantly more likely to be treated with mood-stabilizing co-medication (p=0.030) compared to nonsmokers. Remission rates (p=0.490), as well as a set of metabolic and cognitive variables did not differ between the 2 groups. A related pattern could be observed for the 2- and 5-years analyses.

Conclusions Smoking behavior among clozapine-treated schizophrenia patients might delineate a cohort with an earlier onset of the disease. Nevertheless, most findings comparing disease-specific and clinical outcomes among smokers and nonsmokers were negative. Further research is needed to identify strategies to overcome insufficient remission rates in this patient group.

Supporting Information



Publication History

Received: 27 March 2020
Received: 03 June 2020

Accepted: 22 June 2020

Publication Date:
05 August 2020 (online)

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