Risk of agranulocytosis and neutropenia in patients with Parkinson's disease psychosis receiving clozapine treatment: A systematic review and meta-analysis
Issued Date
2025-01-01
Resource Type
ISSN
01638343
eISSN
18737714
Scopus ID
2-s2.0-85211208459
Journal Title
General Hospital Psychiatry
Volume
92
Start Page
4
End Page
11
Rights Holder(s)
SCOPUS
Bibliographic Citation
General Hospital Psychiatry Vol.92 (2025) , 4-11
Suggested Citation
Limveeraprajak N., Makkapavee W., Likhitsathian S., Srisurapanont M. Risk of agranulocytosis and neutropenia in patients with Parkinson's disease psychosis receiving clozapine treatment: A systematic review and meta-analysis. General Hospital Psychiatry Vol.92 (2025) , 4-11. 11. doi:10.1016/j.genhosppsych.2024.12.003 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/102900
Title
Risk of agranulocytosis and neutropenia in patients with Parkinson's disease psychosis receiving clozapine treatment: A systematic review and meta-analysis
Corresponding Author(s)
Other Contributor(s)
Abstract
Objective: To assess the cumulative incidence of severe neutropenia and agranulocytosis (SNA) and mild and moderate neutropenia (MMN) in patients with Parkinson's disease psychosis (PDP) who receive clozapine treatment. Methods: We searched multiple databases to identify clozapine studies in PDP patients. Incidence rates were assessed during short-term (within 1 month), medium-term (within 6 months), and long-term (> 6 months) monitoring periods. A proportional meta-analysis was performed using random-effects and generalized linear mixed models (GLMMs). Results: We included 691 PDP patients from 19 studies. During the short-term monitoring period, none of the 573 participants in 16 studies developed SNA. The pooled incidence of SNA was 0.001 (95 % confidence interval [CI]: 0.000–0.253, 525 participants, 15 studies) during the medium-term period and 0.002 (95 % CI: 0.000–0.015, 475 participants, 12 studies) during the long-term period. The pooled incidence of MMN was 0.004 (95 % CI: 0.000–0.281, 164 participants, 7 studies) for short- and medium-term periods and 0.013 (95 % CI: 0.002–0.094, 193 participants, 7 studies) in the long-term period. Funnel plot asymmetry indicated potential bias in the medium-term dataset of SNA (p = 0.035). Conclusion: Clozapine treatment in PDP patients may carry a very low risk of SNA and a low risk of MMN.