Clinical response to clozapine in Black people with psychosis: A secondary analysis of an open-label clinical trial
Abstract
Background: Clozapine is the most effective treatment for people with treatment-resistant schizophrenia (TRS). However, clozapine is underutilized, and there are stark racial disparities: Black people with psychosis are less likely to receive clozapine than White people with psychosis. Because of the lack of data on the effectiveness of clozapine in Black people, we sought to determine the clinical response to clozapine in this population.
Objectives: To evaluate clinical response to clozapine in Black people with psychosis to provide evidence that may help reduce disparities in clozapine access.
Design: Secondary analysis of a six-month, prospective, open-label clinical trial examining the safety of clozapine use in Black people.
Methods: We analyzed data from Black people with schizophrenia spectrum disorders (n = 184) from sites in Maryland, USA (n = 97) and Lagos, Nigeria (n = 87). The primary outcome was reduction in symptom severity as measured by the Brief Psychiatric Rating Scale (BPRS) total score over time on clozapine. Additional outcomes included changes in BPRS subscales over time, predictors of 30% improvement in BPRS, clozapine level most predictive of clinical improvement, and the burden of side effects.
Results: BPRS total scores decreased significantly with time on clozapine, with a mean reduction of 8.1 points across sites. BPRS positive and resistance subscale scores also improved significantly. Nigerian participants had higher odds of 30% BPRS…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 184 participants or records.
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