To the Editor Does clozapine offer additional therapeutic benefit to patients who have received inadequate therapeutic benefit from other antipsychotic medications (APMs)? This is the question Samara et al1 aimed to address in their article in JAMA Psychiatry.
When Kane et al2 undertook the comparison of clozapine and chlorpromazine, “inadequate therapeutic benefit” was straightforward: tens of thousands of patients were state-hospitalized in the long-term because they were profoundly psychotic, violent, and/or self-injurious. In 268 of them whose condition did not improve during a high-dose haloperidol lead-in, clozapine handily beat chlorpromazine on psychopathology change. Those of us working in state hospitals as clozapine became available for clinical use noted that the hospitals became less dangerous and then less populous.
McEvoy JP. Use of Clozapine in Schizophrenia. JAMA Psychiatry. 2016;73(10):1097-1098. doi:10.1001/jamapsychiatry.2016.1241