Surveillance hématologique de la clozapine : les temps sont-ils venus d’assouplir les règles ?

Abstract

Background

A significant proportion of people with resistant schizophrenia do not receive treatment with clozapine, despite its clearly established efficacy in this indication. The constraints associated with haematological monitoring are a major obstacle to clozapine use, resulting in a real loss of opportunity for the people concerned.

Objective

The aim of this opinion article is to question the relevance of maintaining the existing haematological monitoring rules for clozapine treatment.

Discussion

Recent studies on the temporal evolution of agranulocytosis risk attributable to clozapine confirm that this risk becomes negligible after one to two years of treatment. Stringent haematological monitoring leads to unjustified discontinuation of clozapine, as transient neutropenic episodes, which may be linked to other causes are common in the general population. Haematological monitoring requires nursing time and sometimes complex organisational adaptations in outpatient facilities to ensure continuity of care, particularly at a time when medical and paramedical staffing levels are low. Haematological monitoring has already been reduced or suspended in several countries after the period of risk of agranulocytosis.

Conclusion

The benefit/risk ratio of maintaining strict haematological monitoring rules for clozapine appears unfavourable, suggesting that the time may have come to reduce the risk of agranulocytosis.