Peer Reviewed

1

Document Type

Article

Publication Date

1-8-2017

Keywords

clozapine G-CSF GM-CSF granulocyte colony stimulating factors schizophrenia treatment-resistant.

Comments

This is a non-final version of an article published in final form in Lally J, Malik S, Whiskey E, Taylor DM, Gaughran FP, Krivoy A, Flanagan RJ, Aleksandar Mijovic A, MacCabe JH. Clozapine-Associated Agranulocytosis Treatment With Granulocyte Colony-Stimulating Factor/Granulocyte-Macrophage Colony-Stimulating Factor: A Systematic Review. Journal of Clinical Psychopharmacology. 2017;37(4):441–446.

Abstract

PURPOSE/BACKGROUND: Clozapine is associated with hematological abnormalities, notably neutropenia, which may progress to agranulocytosis. Granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) have been used to reduce the frequency and duration of clozapine-associated neutropenia. This review aims to explore the use, efficacy, and tolerability of these cytokines in the treatment of clozapine-associated agranulocytosis.

METHODS/PROCEDURES: We conducted a systematic review of published interventional and observational studies, case series, and case reports where G-CSF/GM-CSF was used to treat clozapine-associated agranulocytosis.

FINDINGS/RESULTS: We identified 29 reports (40 patients). The median duration of neutrophil recovery time after stopping clozapine and starting cytokine treatment was 7 days (range, 2-13 days) for those with agranulocytosis (absolute neutrophil count < 0.5 × 10 cells/L). Ninety-four percent (n = 29) had no serious adverse reactions, and no deaths occurred.

IMPLICATIONS/CONCLUSIONS: Our findings indicate that G-CSF/GM-CSF use is well tolerated and suggest that G-CSF can sometimes be safely used to reduce the duration of neutropenia associated with clozapine use. However, the interpretation of this outcome is difficult, given the likely publication bias for positive outcomes in case reports.

Disciplines

Medicine and Health Sciences | Psychiatry and Psychology

Citation

Lally J, Malik S, Whiskey E, Taylor DM, Gaughran FP, Krivoy A, Flanagan RJ, Aleksandar Mijovic A, MacCabe JH. Clozapine-Associated Agranulocytosis Treatment With Granulocyte Colony-Stimulating Factor/Granulocyte-Macrophage Colony-Stimulating Factor: A Systematic Review. Journal of Clinical Psychopharmacology. 2017;37(4):441–446.

PubMed ID

28437295

DOI Link

10.1097/JCP.0000000000000715

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License.

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