Itziar Montalvo , Juan Francisco Delgado , Albert Rodrigo-Parés , Teresa Sagués , Antoni Berenguer-Llergo , Raquel Rodríguez-González , Indira Bhambi , Patricia Pontón , Germà Julià , Virginia Soria , Diego Palao , Javier Labad
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引用次数: 0
Abstract
Background
Schizophrenia, affecting approximately 1 % of the population worldwide, is associated with increased mortality rates and a reduced life expectancy of 10–20 years. Approximately 30 % of cases are resistant to conventional antipsychotic treatments, necessitating the use of clozapine. Recent evidence suggests that clozapine exerts immunomodulatory effects, with individuals undergoing chronic clozapine treatment exhibiting immune profiles resembling primary immunodeficiencies.
Objective
To evaluate the immune response to vaccination with the spike protein of SARS-CoV-2 in schizophrenia patients treated with clozapine, compared to those receiving other antipsychotics.
Methods
The study included 98 patients diagnosed with schizophrenia or schizoaffective disorder, of whom 69 were treated with clozapine. Demographic, clinical, and laboratory data were collected for all participants. Anti-spike protein antibodies were measured using the Elecsys® Anti-SARS-CoV-2 S assay.
Results
No significant differences were observed in demographic, clinical, or laboratory parameters between the groups. Univariate analysis revealed that spike antibody levels were positively associated with smoking habits and more than two exposures to the virus, while they were negatively associated with the time elapsed since vaccination and clozapine dosage.
In multivariate analysis, patients receiving clozapine doses >350 mg/day exhibited a significant reduction in anti-spike antibody levels compared to those not treated with clozapine (fold change = 0.49 [0.24–0.97], p = 0.041) and those receiving <200 mg/day of clozapine (fold change = 0.39 [0.17–0.88], p = 0.024).
Conclusion
High doses of clozapine (>350 mg/day) in patients with schizophrenia and schizoaffective disorders are associated with a diminished immune response to SARS-CoV-2 spike protein vaccination.