Cluster Analysis of Clozapine Consumer Perspectives and Comparison to Consumers on Other Antipsychotics.

• Type of Material: Article
• Authors: Sumeet Sharma, Emory University; Sarah L. Kopelovich, Emory University; A. Umair Janjua, Emory University; Cristina Pritchett, Emory University; Beth Broussard, Emory University; Meena Dhir, Emory University; Joseph G. Wilson, Emory University; David R. Goldsmith, Emory University; Robert Cotes, Emory University
• Language: English
• Date: 2021-01
• Publisher: Oxford University Press
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021. Published by Oxford University Press on behalf of the University of Maryland's school of medicine, Maryland Psychiatric Research Center.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/schizbullopen/sgab043
• Title of Journal or Parent Work: Schizophr Bull Open
• Volume: 2
• Issue: 1
• Start Page: sgab043
• End Page: sgab043
• Grant/Funding Information: This work was supported by NIMH K23 MH114037 (DRG), R25MH101079 (DRG and SS), UL1 TR000424 (Emory Redcap). Outside of this work, ROC has received research funding from Otsuka, Roche, Alkermes, and Lundbeck Pharmaceuticals, and is a consultant to Saladax Biomedical.
• Keywords: schizophrenia spectrum disorders; attitudes; shared decision making
• Research Categories: Health Sciences, Pharmacy; Health Sciences, Health Care Management; Psychology, Clinical; Psychology, Cognitive

Abstract

Despite its unique efficacy, clozapine remains underutilized in the United States. Perceptions about clozapine and barriers to its use have been examined among prescribers, but insufficiently studied among consumers. We surveyed 211 antipsychotic consumers (86 on clozapine and 125 on other antipsychotics) on their medication-related perspectives in a public hospital system in Atlanta, Georgia, USA. In contrast to their previous regimen, 72% of clozapine consumers reported they were more satisfied with clozapine. When compared with consumers taking other antipsychotics, clozapine consumers reported more side effects but did not differ on other measures of satisfaction or efficacy. We found Caucasians to be overrepresented among clozapine, as compared to other antipsychotic consumers. Side effects most strongly associated with poor safety ratings were sedation, limb jerking, and dizziness when standing. However, clozapine was only rated less safe by consumers who experienced more than one of these side effects. We used an unsupervised clustering approach to identify three major groups of clozapine consumers. Cluster A (19%) had the lowest safety ratings, aversion to blood work, and a high rate of side effects that associate with lower safety ratings. Cluster B (25%) experienced more hospitalizations and reported satisfaction with clozapine that correlated with efficacy ratings, irrespective of safety ratings. Cluster C (56%) experienced fewer hospitalizations, fewer previous drug trials, greater educational attainment, lower rates of smoking, and rated clozapine more highly. This work identifies common side effects that influence the subjective safety of clozapine and suggests that attitudes toward clozapine depend on context-specific factors.