Clozapine for persons with neurodevelopmental disorders: a systematic review and expert recommendations for clinical practice.

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Expert Review of Clinical Pharmacology Pub Date : 2024-10-03 DOI:10.1080/17512433.2024.2410395

Hélène Verdoux, Clélia Quiles, Jose de Leon

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Abstract

Introduction: We aimed to synthesize the information on the risks and benefits of clozapine prescription for resistant challenging behavior in persons with neurodevelopmental disorders.

Methods: Articles were identified with MEDLINE, Web of Sciences, and PsycINFO search from inception through January 2024. The review was restricted to persons with intellectual disability (ID) and/or autism spectrum disorder (ASD) without comorbid psychotic or affective disorder. Data were synthesized narratively.

Results: We identified 24 articles (13 case reports, eight chart studies, two controlled studies, one pharmaco-epidemiological study) including 296 patients with ID (n = 222) or ASD (n = 74) (10% aged ≤ 18 years). After clozapine initiation, a decreased frequency of challenging behavior persisting over time was reported in most participants included in clinical studies, and a significant reduction in the number of admissions in the population-based two-year mirror-image study. Adverse drug reactions were those commonly observed with clozapine, i.e. constipation, sedation, and weight gain.

Conclusions: Since only four participants were included in the controlled studies, the benefits of clozapine in neurodevelopmental disorders are supported by a body of evidence exclusively drawn from observational studies. Further studies are required to clarify the indications of clozapine with respect to the unmet need induced by resistant challenging behavior.

Registration: PROSPERO database registration number CRD42024522343.

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用于神经发育障碍患者的氯氮平：系统综述和临床实践专家建议。

简介我们旨在综合有关氯氮平处方治疗神经发育障碍患者耐受性挑战行为的风险和益处的信息：通过MEDLINE、Web of Sciences和PsycINFO检索发现了从开始到2024年1月的文章。研究对象仅限于智力障碍（ID）和/或自闭症谱系障碍（ASD）患者，且不合并精神病或情感障碍。对数据进行了叙述性综合：我们发现了 24 篇文章（13 篇病例报告、8 篇图表研究、2 篇对照研究、1 篇药物流行病学研究），其中包括 296 名智障患者（n = 222）或自闭症谱系障碍患者（n = 74）（10% 年龄小于 18 岁）。据报道，在开始使用氯氮平之后，大多数参与临床研究的患者在一段时间内持续出现挑战性行为的频率有所降低，而在为期两年的人群镜像研究中，入院人数也显著减少。药物不良反应是氯氮平常见的不良反应，如便秘、镇静、体重增加等：由于只有四名参与者参与了对照研究，因此氯氮平对神经发育障碍的益处得到了大量证据的支持，这些证据完全来自观察性研究。还需要进一步的研究，以明确氯氮平在抵抗性挑战行为引起的未满足需求方面的适应症：PROSPERO数据库注册号为CRD42024522343。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Clinical Pharmacology PHARMACOLOGY & PHARMACY-

CiteScore

7.30

自引率

2.30%

发文量

127

期刊介绍： Advances in drug development technologies are yielding innovative new therapies, from potentially lifesaving medicines to lifestyle products. In recent years, however, the cost of developing new drugs has soared, and concerns over drug resistance and pharmacoeconomics have come to the fore. Adverse reactions experienced at the clinical trial level serve as a constant reminder of the importance of rigorous safety and toxicity testing. Furthermore the advent of pharmacogenomics and ‘individualized’ approaches to therapy will demand a fresh approach to drug evaluation and healthcare delivery. Clinical Pharmacology provides an essential role in integrating the expertise of all of the specialists and players who are active in meeting such challenges in modern biomedical practice.