Risk of readmission in patients with schizophrenia and schizoaffective disorder newly prescribed clozapine

• Published in: Journal of psychopharmacology (Oxford) Vol. 33; no. 4; pp. 449 - 458
• Main Authors: Kesserwani, Jad, Kadra, Giouliana, Downs, Johnny, Shetty, Hitesh, MacCabe, James H, Taylor, David, Stewart, Robert, Chang, Chin-Kuo, Hayes, Richard D
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-04-2019; Sage Publications Ltd
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antipsychotic Agents - therapeutic use; Antipsychotics; Clozapine; Clozapine - therapeutic use; Confidence intervals; Female; Health hazards; Health risk assessment; Health services; Humans; Indication; Male; Mental disorders; Mental health; Middle Aged; Olanzapine; Original Papers; Patient Readmission - statistics & numerical data; Proportional Hazards Models; Psychotic Disorders - drug therapy; Regression analysis; Retrospective Studies; Risk reduction; Schizophrenia; Schizophrenia - drug therapy; Sensitivity; Statistical analysis; Young Adult; Clozapine; schizophrenia; readmission; atypical antipsychotics; schizoaffective disorder
• ISSN: 0269-8811; 1461-7285; 1461-7285
• DOI: 10.1177/0269881118817387

Background:
Insight into the effect of clozapine is limited by a lack of controlling for confounding variables in current research. Our objective was to investigate the association between clozapine prescribed at discharge, following an inpatient episode, and risk of readmission into secondary mental health services in patients with schizophrenia and schizoaffective disorder, controlling extensively for confounding variables.
Methods:
Clinical records from 3651 patients were analysed in a retrospective observational cohort study. Cox proportional-hazards regression models were used to assess the risk of hospital readmission. A series of sensitivity analyses were also conducted. Propensity score methods were used to address confounding-by-indication.
Results:
Patients on clozapine (n=202) had a reduced risk of readmission compared with patients on other antipsychotics (adjusted hazard ratio=0.79; 95% confidence interval: 0.64–0.99; p=0.043). Clozapine also had a protective effect on risk of readmission when compared with olanzapine (adjusted hazard ratio 0.76; 95% confidence interval: 0.60–0.96; p=0.021). The effect size remained consistent after adjusting for an array of possible confounders, as well as using propensity scores to address confounding-by-indication. A statistically significant result was also noted in all but two sensitivity analyses.
Conclusion:
Our findings suggest that clozapine is associated with a reduced risk of readmission into secondary mental health services.