한국에서 11년간 Clozapine 투여에 의한 무과립구증과 호중구감소증
Clozapine-induced Agranulocytosis and Neuropenia for 11 Years in South Korea
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목 적： Clozapine은 치료저항성 정신분열병환자의 치료에 많이 사용되고 있지만 생명을 위협하는 혈액학적 부작용 때문에 사용에 많은 제한이 따른다. 본 연구자들은 한국에서 장기간의 clozapine 투여에 의한 무과립구증과 호중구감소증의 전체 발생률과 투여 기간에 따른 발생률의 변화를 알아보고자 한다. 방 법： 1993년 2 월부터 204년 2월까지 1년간 Clozaril Patient Monitoring System(CPMS)에 등록된 7367명 중 분석 기준에 합당한 6,782명의 자료를 분석하였다.
Abstract
Objectives : Clozapine is effective in treating patients with treatment-resistant schizophrenia. Because of producing a potentially fatal agranulocytosis, the use of clozapine is restricted to patients who are resistant to, or intolerant of, conventional antipsychotic medication. This study documents the incidence of agranulocytosis and neutropenia, and pattern of variation in incidence of these side effects in a long-term clozapine treatment. Methods : An analysis was made of the hematological, demographic, and other characteristics data from Clozaril Patient Monitoring System(CPMS) data on 6782 patients on clozapine over about 11 years in South Korea. Results : During the study period, agranulocytosis developed in 54 patients with 29 (53.7%) cases within 18 weeks. The cumulative incidence of agranulocytosis was 1.64% at 6 to 11 years and the crude incidence was 0.8%, with the hazard rates peaking during the 3rd month(0.0025) and 2nd month(0.0014). Neutropenia occurred in 697 patients, and 365(52.4%) cases developed within 18 weeks. The cumulative incidence of this blood abnormality was 19.8% at 8 to 11 years, and the crude incidence was 10.3% and the hazard rates peaked during the 2nd month(0.0188). Conclusions : These results showed that the incidence of agranulocytosis in South Korea is similar to that in the rest of the world. Because of agranulocytosis that occurred after several years of clozapine use, long-term monitoring of patients' white blood cell counts is necessary. In the future, studies of reducing the frequency of hematologic monitoring are needed, and the concept of "transient agranulocytosis" should be taken into consideration.
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