Evidence map›Paper›PMID 36943247›Full record

GuidelineSchizophrenia bulletin2023

Clozapine Optimization: A Delphi Consensus Guideline From the Treatment Response and Resistance in Psychosis Working Group.

Elias Wagner, Dan Siskind, Peter Falkai, Oliver Howes, Christoph Correll, Jimmy Lee, William G Honer, John M Kane, Emilio Fernandez-Egea, Thomas R E Barnes and 2 more

Open access · bronzeAbstract readPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in Schizophrenia bulletin, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed
7.8field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 35 citations in OpenAlex.

  1. Real-world comprehensive care of people living with schizophrenia: recommendations across different settings and clinical stages.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 9 institutions in 6 countries.

Elias WagnerDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
Dan SiskindDepartment of Psychiatry, School of Medicine, University of Queensland, Brisbane, Australia.
Peter FalkaiDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
Oliver HowesDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Christoph CorrellDepartment of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA.
Jimmy LeeDepartment of Psychosis, Institute of Mental Health, Singapore.ORCID 0000-0002-7724-7445
William G HonerDepartment of Psychiatry, Institute of Mental Health, The University of British Columbia, Vancouver, Canada.
John M KaneDepartment of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA.
Emilio Fernandez-EgeaCambridge Psychosis Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.ORCID 0000-0003-4128-8955
Thomas R E BarnesDivision of Psychiatry, Imperial College London, London, UK.
Alkomiet HasanDepartment of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany.
TRRIP Working Group
Feinstein Institute for Medical Research · USLMU Klinikum · DEImperial College London · GBKing's College London · GBUniversity of Cambridge · GBNanyang Technological University · SGThe University of Queensland · AUUniversity of British Columbia · CAUniversity of Augsburg · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and hypothesisThere is limited evidence to guide the approaches to clozapine treatment. Accordingly, an international initiative was undertaken with the aim of developing consensus recommendations for the optimization of clozapine monotherapy. STUDY

designWe conducted an online Delphi survey among members of the Treatment Response and Resistance in Psychosis (TRRIP) working group comprising experts from twenty-nine countries. The threshold criterion for a consensus recommendation was ≥ 75% agreement ("agree" and "strongly agree" responses) on a question. Agreement of ≥ 50% but < 75% in a second or third Delphi round was deemed to provide guidance. STUDY

resultsForty-nine (first round), 32 (second round), and 48 (third round) of the 91 current TRRIP members participated. Expert recommendations at ≥ 75% comprised second-line treatment with clozapine in cases of persistent positive symptoms with co-occurring extrapyramidal symptoms, tardive dyskinesia, or suicidality/aggression. There was considerable disagreement on myocarditis screening parameters. The management of somatic and neuropsychiatric adverse drug reactions warrants further research for more evidence-based recommendations. Rechallenge with clozapine was recommended for eosinophilia, sinus tachycardia and fever and guidance (agreement ≥ 50%) was reached for pneumonia and thrombocytopenia.

conclusionsGiven the limited evidence available, this consensus-based series of recommendations and guidance statements supports clinical decision-making to optimize clozapine monotherapy and provides guidance for future research in treatment-resistant schizophrenia.

Indexed as

ClozapinePsychotic DisordersConsensusDelphi TechniqueHumansClozapineclozapineconsensusDelphischizophrenia

Identifiers

PMID36943247
PMCPMC10318876
OpenAlexW4328048427

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.