Determinants of patient satisfaction in clozapine users: results from the Clozapine International Consortium (CLOZIN)

Abstract

Clozapine is highly effective for treatment-resistant schizophrenia but is underutilized due to patient and clinician-related concerns. Little is known about the general level of patient satisfaction with clozapine and determinants thereof. We therefore explored determinants of patient satisfaction with clozapine in individuals diagnosed with schizophrenia spectrum disorders (SSDs). Cross-sectional data from 480 clozapine users were used to examine demographic and clinical factors, including symptom severity, treatment response, and adverse drug reactions (ADRs). Patient satisfaction was self-rated on a scale of 1 to 10. Results showed a mean satisfaction score of 7.4 (SD = 1.9), with significant associations between satisfaction and treatment response (B = 0.42, R² = 0.19, p = 3.9 × 10⁻¹⁸), symptom severity (B = 0.10, R² = 0.05, p = 2.06 × 10^-9), occurrence of ADRs (B = -0.16, R² = 0.06, p = 3.2 × 10^-5), and recreational drug use (B = -1.32, R² = 0.05, p = 2.09 × 10^-4). Hypersalivation and prolonged sleep duration were the only ADRs linked to lower satisfaction (B = -0.72, R² = 0.06, p = 3.5 × 10^-5 and B = -0.57, R² = 0.04, p = 1.4 × 10^-3, respectively). Despite concerns about ADRs, treatment effectiveness showed a stronger association with patient satisfaction among clozapine users than the occurrence of ADRs. In conclusion, our findings suggest that strategies aimed at bolstering clozapine's effectiveness may help counter worldwide underprescription rates of clozapine in patients with SSDs.

Fig. 1. Association of patient satisfaction with treatment response and symptom severity.

Bar charts illustrating the association of mean patient satisfaction rating with response as rated using the Alda-A criterium (A) and with symptom severity rated using the CGI-scale (B). The numbers denoted in each bar refer to the mean patient satisfaction rating of that group. Criterium A of the Alda scale was used to determine an association between clinical improvement and the treatment on a scale of 0 (no change or worsening) to 10 (complete response)^,. For illustrative purposes, a score of 1–2 is labeled as 'minimal' response, 3–4 as 'mild' response, 5–6 as ‘moderate’ response, 7–8 as 'good' response, and 9–10 as 'very good' response. Abbreviations: CGI Clinical Global Impression.