The prevalence of agranulocytosis and related death in clozapine-treated patients: a comprehensive meta-analysis of observational studies

Clozapine treatment increases the risk of agranulocytosis, but findings on the epidemiology of agranulocytosis have been inconsistent. This meta-analysis examined the prevalence of agranulocytosis and related death in clozapine-treated patients. A literature search in the international (PubMed, Psyc...

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Bibliographic Details
Published in:Psychological medicine 2020-03, Vol.50 (4), p.583-594
Main Authors: Li, Xiao-Hong, Zhong, Xiao-Mei, Lu, Li, Zheng, Wei, Wang, Shi-Bin, Rao, Wen-Wang, Wang, Shuai, Ng, Chee H, Ungvari, Gabor S, Wang, Gang, Xiang, Yu-Tao
Format: Article
Language:English
Subjects:
Agranulocytosis - chemically induced
Agranulocytosis - epidemiology
Agranulocytosis - mortality
Antipsychotic Agents - adverse effects
Blood
Cause of Death
Clozapine
Clozapine - adverse effects
Death
Death & dying
Drug-Related Side Effects and Adverse Reactions - epidemiology
Drug-Related Side Effects and Adverse Reactions - mortality
Epidemiology
Fatalities
Humans
Infrastructure
Meta-analysis
Monitoring systems
Mortality
Neutropenia
Neutrophils
Observational studies
Observational Studies as Topic
Prevalence
Quality
Schizophrenia
Systematic review
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Summary:Clozapine treatment increases the risk of agranulocytosis, but findings on the epidemiology of agranulocytosis have been inconsistent. This meta-analysis examined the prevalence of agranulocytosis and related death in clozapine-treated patients. A literature search in the international (PubMed, PsycINFO, and EMBASE) and Chinese (WanFang, Chinese National Knowledge Infrastructure, and Sinomed) databases was conducted. Prevalence estimates of agranulocytosis and related death in clozapine-treated patients were synthesized with the Comprehensive Meta-Analysis program using the random-effects model. Thirty-six studies with 260 948 clozapine-treated patients published between 1984 and 2018 were included in the meta-analysis. The overall prevalence of agranulocytosis and death caused by agranulocytosis were 0.4% (95% CI 0.3-0.6%) and 0.05% (95% CI 0.03-0.09%), respectively. The prevalence of agranulocytosis was moderated by sample size, study quality, year of publication, and that of data collection. The prevalence of clozapine-associated agranulocytosis is low. Agranulocytosis-related death appears rare.
ISSN:0033-2917
1469-8978
DOI:10.1017/s0033291719000369