Metabolic Problems Among People With Treatment-Resistant Schizophrenia are Not Unique to Clozapine

It is unclear whether treatment with clozapine, when compared directly with other antipsychotics, is differentially associated with metabolic problems among people with treatment-resistant schizophrenia (TRS). We evaluated the prevalence of diabetes, dyslipidemia, obesity, and hypertension, and parameters such as glucose, lipids, weight, and blood pressure of people with TRS managed on clozapine and non-clozapine antipsychotics.

Demographic, clinical, and metabolic data of patients with TRS who commenced clozapine between 2006 and 2016 at a public hospital were collected in 2023. Participants were divided into those who were on clozapine and those who had discontinued clozapine and were on other antipsychotics when the data were collected. Metabolic disorders of the 2 groups were compared with the t test, the χ 2 test, and the Mann-Whitney U test. The significance level was set at P <0.05.

One hundred six participants with TRS were on treatment with clozapine, and 41 with other antipsychotics. The participants' mean age was 44.3 (SD: 10.2) years, and 74.1% were males. Metabolic disorders such as dyslipidemia (45.6%), obesity (37.4%), and diabetes (22.1%) were prevalent among people with TRS. However, there was no significant difference in diabetes, obesity, and hypertension, and parameters such as blood sugar, lipid levels, and blood pressure between the clozapine and non-clozapine cohorts. While dyslipidaemia was significantly higher among those who were managed on clozapine, 75% of them were prescribed statins.

A comprehensive approach addressing a broad range of risk factors, rather than solely focusing on clozapine, could be beneficial when evaluating and treating metabolic problems among people with TRS.