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No. 4 (2025)

GENERAL THERAPY QUESTIONS AND REVIEWS

Augmentation of Clozapine with Another Antipsychotic in Treatment-Resistant Schizophrenia (Systematic Analysis of Randomised Controlled Trials)

https://doi.org/10.48612/psyph/mkbu-d67z-puxb

Published 2025-12-30

  • D.R. Bulatova
    • ,
  • D.I. Malin

D.R. Bulatova
V. Serbsky Federal Medical Research Centre of Psychiatry and Narcology

D.I. Malin
V. Serbsky Federal Medical Research Centre of Psychiatry and Narcology

Abstract

The presented systematic review assesses the efficacy of clozapine augmentation with other antipsychotics in clozapine-resistant schizophrenia (CRS). The review was performed according to the PRISMA criteria and included 20 randomized controlled trials (RCTs) involving 1192 patients with an observation period of 6 to 52 weeks. The study found that amisulpride is the most effective antipsychotic, which allows achieving a therapeutic effect with a reduction in positive and negative psychopathological symptoms when added to clozapine in CRS. Aripiprazole had little effect on the dynamics of productive psychopathological symptoms, but led to a decrease in body weight, cholesterol and low-density lipoprotein levels in the blood serum and eliminated hyperprolactinemia syndrome. Most of the studies included in the review have a number of limitations. The studies included in the review differ in evaluation methods, scale and year of implementation, selection criteria, nature and duration of therapy. The results of many studies are based on single RCTs with a small number of patients and a high risk of a second type error, which does not exclude a false negative result.

Keywords

schizophrenia, clozapine- resistance, clozapine аugmentation

PDF (Русский)

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