Key clinical point: Clozapine adherence is at least comparable, if not slightly better, compared with other antipsychotics in patients with schizophrenia.

Major finding: Adherence rate and adherence using a recommended threshold (≥80%) were numerically superior in patients receiving clozapine vs. other antipsychotics (72.0% vs. 65.1%; P = .10 and 49.5% vs. 35.7%; P = .11, respectively). Similarly, adherence outcomes in terms of missed dose and medication gaps were significantly better in patients receiving clozapine vs. other antipsychotics.

Study details: This 3-month prospective study evaluated adherence to clozapine (n = 33) vs. other antipsychotics (n = 78) in patients with schizophrenia using electronic adherence monitoring.

Disclosures: This study was supported through the Canadian Institutes of Health Research, awarded to Dr. Remington. Dr. Takeuchi, Dr. Agid, and Dr. Remington reported relationships with pharmaceutical companies.

Commentary

“Poor medication adherence is a pervasive problem that is associated with relapse, hospitalization and even suicide in the most unfortunate situations. People with schizophrenia encounter multiple barriers to adherence, including drug side effects or treatment burden such as the blood monitoring required during clozapine therapy. This study highlights several key points regarding medication adherence in schizophrenia. First, the use of electronic adherence monitoring (EAM) as a tool to help assess adherence. As technologies continue to improve, EAM may be increasingly feasible and practical. Second, adherence is a complex behavior driven by a number of factors, including support networks and other resources. Additionally, adherence behaviors need to be monitored (and discussed) longitudinally in order to optimize treatment planning and collaboration between clinicians and their patients with schizophrenia. Adherence barriers are often patient-specific and cannot uniformly determined based upon a specific antipsychotic drug side effect profile or treatment burden.”

Martha Sajatovic, MD

Professor of Psychiatry and of Neurology

Willard Brown Chair in Neurological Outcomes Research

Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center

Case Western Reserve University School of Medicine