Patrón de uso de clozapina en España. Variabilidad e infraprescripción / Pattern of use of clozapine in Spain. Variability and under-prescription

Introducción: Los datos internacionales disponibles sobre uso de clozapina recogen en general una baja prescripción, infradosificación y retraso en el inicio del tratamiento, y han originado diversas iniciativas para mejorar su uso y disminuir la llamativa variabilidad. No disponemos de estudios que valoren estos aspectos en población española, por lo que nos hemos planteado una primera y modesta aproximación a través de 4 muestras territoriales. Nuestra hipótesis es que, al igual que las referencias comentadas, en nuestro país el consumo de clozapina podría ser bajo y variable. Nuestro objetivo, en caso de confirmarse la hipótesis, sería iniciar una reflexión sobre posibles estrategias a plantear. Material y métodos: Los autores han accedido a datos de consumo de clozapina en Cataluña, Castilla y León, País Vasco y un Área de Madrid (el Área de Gestión Clínica PSM del Hospital 12 de Octubre). Resultados: Los pacientes con diagnóstico de esquizofrenia en tratamiento en los territorios estudiados oscilan en torno al 0,3%; los tratamientos con clozapina/10.000 habitantes entre el 33% y 57%; y los pacientes diagnosticados como esquizofrenia en tratamiento con clozapina suponen entre el 13,7% y 18,6% de los tratados. El coeficiente de variación entre centros y prescriptores es frecuentemente superior al 50%. Conclusiones: Aunque por debajo de las cifras indicadas por la literatura, los datos globales de prescripción de clozapina en los territorios que hemos estudiado no son tan bajos como los recogidos en otros trabajos internacionales, y se sitúan en el rango de países de nuestro entorno. Sin embargo, la variabilidad en la prescripción es muy importante, aparentemente no justificada; y aumenta a medida que analizamos zonas menores, hasta una gran heterogeneidad de la prescripción individual

Introduction: International studies on clozapine use usually show lower than expected prescription proportions, under-dosing and delayed initiation of treatment, which has led to a number of initiatives aimed at improving its use and reducing the striking variability observed among practitioners. There are no similar studies on the Spanish population. Therefore we planned initial data collection from 4 territorial samples. We hypothesized that clozapine prescription would also be low and variable in our country. If this hypothesis were confirmed, a reflection on possible strategies would be necessary. Material and methods: We accessed data on clozapine prescription in Catalonia, Castile and Leon, the Basque Country and the Clinical Management Area of the Hospital 12 de Octubre (Madrid). Results: Patients diagnosed with schizophrenia under treatment in these territories comprise around .3% of their total population; treatment with clozapine ranges between 33.0 and 57.0 per 10000 inhabitants; patients diagnosed with schizophrenia on current treatment with clozapine range between 13.7% and 18.6% of the total number of patients with this diagnosis. The coefficient of variation between centres and prescribers is often higher than 50%. Conclusions: Although below the figures suggested as desirable in the literature, global prescribing data for clozapine in the areas we studied are not as low as the data collected in other international studies, and are in the range of countries in our environment. However, the variability in prescription is large and apparently not justified; this heterogeneity increases as we focus on smaller areas, and there is great heterogeneity at the level of individual prescription

Pattern of use of clozapine in Spain. Variability and under-prescription. / Patrón de uso de clozapina en España. Variabilidad e infraprescripción.

INTRODUCTION: International studies on clozapine use usually show lower than expected prescription proportions, under-dosing and delayed initiation of treatment, which has led to a number of initiatives aimed at improving its use and reducing the striking variability observed among practitioners. There are no similar studies on the Spanish population. Therefore we planned initial data collection from 4 territorial samples. We hypothesized that clozapine prescription would also be low and variable in our country. If this hypothesis were confirmed, a reflection on possible strategies would be necessary. MATERIAL AND METHODS: We accessed data on clozapine prescription in Catalonia, Castile and Leon, the Basque Country and the Clinical Management Area of the Hospital 12 de Octubre (Madrid). RESULTS: Patients diagnosed with schizophrenia under treatment in these territories comprise around .3% of their total population; treatment with clozapine ranges between 33.0 and 57.0 per 10000 inhabitants; patients diagnosed with schizophrenia on current treatment with clozapine range between 13.7% and 18.6% of the total number of patients with this diagnosis. The coefficient of variation between centres and prescribers is often higher than 50%. CONCLUSIONS: Although below the figures suggested as desirable in the literature, global prescribing data for clozapine in the areas we studied are not as low as the data collected in other international studies, and are in the range of countries in our environment. However, the variability in prescription is large and apparently not justified; this heterogeneity increases as we focus on smaller areas, and there is great heterogeneity at the level of individual prescription.

Síndrome metabólico y antipsicóticos atípicos. Posibilidad de predicción y control / Metabolic syndrome and atypical antipsychotics: possibility of prediction and control

Introducción. La esquizofrenia y otros trastornos psicóticos se asocian a una elevada morbimortalidad debido a factores de salud inherentes a la propia enfermedad, factores genéticos y factores asociados al tratamiento psicofarmacológico. Los antipsicóticos, al igual que otros fármacos, presentan efectos secundarios que pueden repercutir de manera sustancial en la salud física de los pacientes, existiendo diferencias importantes en cuanto al perfil de efectos secundarios y en los pacientes en que se producen dichos efectos. Conocer e identificar estos grupos de riesgo podría contribuir a prevenir la aparición de los efectos indeseados. Material y método. Estudio prospectivo, de seguimiento a 24 meses, para analizar la salud física de los pacientes mentales graves en tratamiento de mantenimiento con antipsicóticos atípicos con el fin de verificar la existencia de parámetros predictores a nivel antropométrico y/o analítico para la buena/mala evolución del síndrome metabólico en estos pacientes. Resultados. No hubo cambios significativos de los parámetros físicos y bioquímicos estudiados individualmente a lo largo de las diferentes visitas. El perímetro abdominal basal (lamba de Wilks p=0,013) y los niveles de colesterol HDL basal (lamba de Wilks p=0,000) son los parámetros que parecen tener mayor relevancia, por encima del resto de los criterios diagnósticos constituyentes del síndrome metabólico, como factores predictores en la evolución a largo plazo. Conclusiones. En la búsqueda de parámetros predictores del síndrome metabólico resultaron seleccionados el colesterol HDL y el perímetro abdominal en el momento de la inclusión, de modo que a peores valores iniciales, mayor probabilidad de mejoría a largo plazo (AU)

Introduction. Schizophrenia and other psychotic disorders are associated with high morbidity and mortality, due to inherent health factors, genetic factors, and factors related to psychopharmacological treatment. Antipsychotics, like other drugs, have side-effects that can substantially affect the physical health of patients, with substantive differences in the side-effect profile and in the patients in which these side-effects occur. To understand and identify these risk groups could help to prevent the occurrence of the undesired effects. Material and method. A prospective study, with 24 months follow-up, was conducted in order to analyse the physical health of severe mental patients under maintenance treatment with atypical antipsychotics, as well as to determine any predictive parameters at anthropometric and/or analytical level for good/bad outcome of metabolic syndrome in these patients. Results. There were no significant changes in the physical and biochemical parameters individually analysed throughout the different visits. The baseline abdominal circumference (lambda Wilks P=.013) and baseline HDL-cholesterol levels (lambda Wilks P=.000) were the parameters that seem to be more relevant above the rest of the metabolic syndrome constituents diagnosis criteria as predictors in the long-term. Conclusions. In the search for predictive factors of metabolic syndrome, HDL-cholesterol and abdominal circumference at the time of inclusion were selected, as such that the worst the baseline results were, the higher probability of long-term improvement (AU)

Metabolic syndrome and atypical antipsychotics: Possibility of prediction and control. / Síndrome metabólico y antipsicóticos atípicos. Posibilidad de predicción y control.

INTRODUCTION: Schizophrenia and other psychotic disorders are associated with high morbidity and mortality, due to inherent health factors, genetic factors, and factors related to psychopharmacological treatment. Antipsychotics, like other drugs, have side-effects that can substantially affect the physical health of patients, with substantive differences in the side-effect profile and in the patients in which these side-effects occur. To understand and identify these risk groups could help to prevent the occurrence of the undesired effects. MATERIAL AND METHOD: A prospective study, with 24 months follow-up, was conducted in order to analyse the physical health of severe mental patients under maintenance treatment with atypical antipsychotics, as well as to determine any predictive parameters at anthropometric and/or analytical level for good/bad outcome of metabolic syndrome in these patients. RESULTS: There were no significant changes in the physical and biochemical parameters individually analysed throughout the different visits. The baseline abdominal circumference (lambda Wilks P=.013) and baseline HDL-cholesterol levels (lambda Wilks P=.000) were the parameters that seem to be more relevant above the rest of the metabolic syndrome constituents diagnosis criteria as predictors in the long-term. CONCLUSIONS: In the search for predictive factors of metabolic syndrome, HDL-cholesterol and abdominal circumference at the time of inclusion were selected, as such that the worst the baseline results were, the higher probability of long-term improvement.

Factores determinantes del riesgo metabólico en el tratamiento con antipsicóticos atípicos / No disponible

No disponible