@article{ref1,
title="Clozapine and mortality: A comparison with other antipsychotics in a nationwide Danish cohort study",
journal="Acta psychiatrica Scandinavica",
year="2021",
author="van der Zalm, Yvonne and Foldager, Leslie and Termorshuizen, Fabian and Sommer, Iris E. and Nielsen, Jimmi and Selten, Jean-Paul",
volume="143",
number="3",
pages="216-226",
abstract="OBJECTIVE: To compare the mortality in people using clozapine to that of people using other antipsychotics. METHODS: Danish incidence cohort of 22,110 patients with a first diagnosis of non-affective psychotic disorder (1995-2013) and a prevalence cohort of 50,881 patients ever diagnosed with such a disorder (1969-2013). Hazard ratios (HR) were calculated for the antipsychotic drug used at the time of death (&quot;current use&quot;: incidence and prevalence cohort) and for the drug used for the longest at that moment (&quot;cumulative use&quot;: incidence cohort), using a Cox model with adjustment for somatic comorbidity. Clozapine was the reference drug. RESULTS: As for current drug use, the risk of suicide was higher among users of other antipsychotics in the incidence (HRadj  = 1.76; 95% CI 0.72-4.32) and prevalence (HRadj  = 2.20; 95% CI 1.35-3.59) cohorts. There was no significant difference in all-cause or cardiovascular mortality in the two cohorts. Cumulative use of clozapine was not associated with an increased cardiovascular mortality. Cumulative use of other antipsychotics for up to 1 year was associated with a lower all-cause mortality and suicide risk than a similar period of clozapine use (all-cause: HRadj  = 0.73; 95% CI 0.63-0.85, suicide; HRadj  = 0.65; 95% CI 0.46-0.91). CONCLUSION: The results indicate that the use of clozapine is not associated with increased cardiovascular mortality. We found opposing trends toward a lower risk of suicide during current use of clozapine and a higher risk of suicide associated with cumulative use up to 1 year. This suggests that clozapine cessation marks a period of high risk of suicide.<p /><p>Language: en</p>",
language="en",
issn="0001-690X",
doi="10.1111/acps.13267",
url="http://dx.doi.org/10.1111/acps.13267"
}