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

Published online by Cambridge University Press:  12 March 2019

Xiao-Hong Li ,
Xiao-Mei Zhong ,
Li Lu ,
Wei Zheng ,
Shi-bin Wang ,
Wen-wang Rao ,
Shuai Wang ,
Chee H. Ng ,
Gabor S. Ungvari  and
Gang Wang
...Show all authors
Xiao-Hong Li
Affiliation:
The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & the Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China
Xiao-Mei Zhong
Affiliation:
The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
Li Lu
Affiliation:
Unit of Psychiatry, Centre of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
Wei Zheng
Affiliation:
The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
Shi-bin Wang
Affiliation:
Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
Wen-wang Rao
Affiliation:
Unit of Psychiatry, Centre of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
Shuai Wang
Affiliation:
The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & the Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China
Chee H. Ng
Affiliation:
Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
Gabor S. Ungvari
Affiliation:
University of Notre Dame Australia, Fremantle, Australia Division of Psychiatry, Medical School, University of Western Australia, Perth, Australia
Gang Wang*
Affiliation:
The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & the Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China
Yu-Tao Xiang*
Affiliation:
Unit of Psychiatry, Centre of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
*
Author for correspondence: Yu-Tao Xiang, E-mail: xyutly@gmail.com; Gang Wang, E-mail: gangwangdoc@gmail.com
Author for correspondence: Yu-Tao Xiang, E-mail: xyutly@gmail.com; Gang Wang, E-mail: gangwangdoc@gmail.com
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

The prevalence of clozapine-associated agranulocytosis is low. Agranulocytosis-related death appears rare.

Keywords

Agranulocytosisclozapineprevalencemeta-analysis
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 4 , March 2020 , pp. 583 - 594
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

PROSPERO registration No.: CRD42017068158.

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