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Global trends in clozapine utilisation between 2014 and 2024: a longitudinal epidemiological study with data from 75
Ita Fitzgerald1,2,3, Sarah O'Dwyer4, Ciara Ní Dhubhlaing1,2,3
1Pharmacy Department, St Patrick's Mental Health Services, Dublin, Ireland.
The Lancet Regional Health. Europe
|February 13, 2026
Summary
Clozapine use for treatment-resistant schizophrenia is increasing globally but varies significantly between countries. Strategies beyond relaxed monitoring are needed to boost clozapine utilization.
Area of Science:
- Psychiatry
- Pharmacology
- Public Health
Background:
- Clozapine underutilization in treatment-resistant schizophrenia is a global public health concern.
- Investigating international clozapine utilization trends is crucial for addressing this challenge.
Purpose of the Study:
- To analyze contemporary trends in clozapine utilization across 75 countries.
- To identify factors associated with variations in clozapine use.
Main Methods:
- Utilized national prescribing databases and global pharmaceutical sales data (IQVIA).
- Calculated annual national prevalence of clozapine use (DDD/1000 inhabitants/day) from 2014-2024.
- Employed linear regression to test time trends and explored psychiatrist numbers and monitoring stringency as predictors.
Main Results:
- Global average clozapine utilization reached 0.46 DDD/1000 inhabitants/day in 2024, with significant variations (e.g., New Zealand 2.99, Singapore 0.0007).
- Worldwide clozapine use increased by 0.13 DDD/1000 inhabitants/day over the study period.
- Higher psychiatrist numbers correlated with increased clozapine use, while monitoring stringency did not.
Conclusions:
- Despite a global increase, substantial intercountry disparities in clozapine use persist.
- The lack of association between monitoring stringency and utilization suggests that policy and practice changes beyond monitoring are necessary to systematically enhance clozapine use.
Keywords:
ClozapineDrug utilisationGlobal healthPrescribingPrescribing trendsSchizophreniaTreatment resistant schizophreniaMore Related Videos
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