Quality statement 4: Treatment with clozapine

Quality statement

Adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs are offered clozapine.

Rationale

Clozapine is the only drug with established efficacy in reducing symptoms and the risk of relapse for adults with treatment‑resistant schizophrenia. It is licensed only for use in service users whose schizophrenia has not responded to, or who are intolerant of, conventional antipsychotic drugs.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotics drugs (at least 1 of which should be a non‑clozapine second‑generation antipsychotic) are offered clozapine.

Data source: Local data collection.

Process

Proportion of adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs (at least 1 of which should be a non‑clozapine second‑generation antipsychotic) who receive clozapine.

Numerator – the number in the denominator who receive clozapine.

Denominator – the number of adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs (at least 1 of which should be a non‑clozapine second‑generation antipsychotic).

Data source: Local data collection.

Outcome

Relapse rates of schizophrenia in adults.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as GP practices, community health services, mental health services and hospitals) ensure that there are procedures and protocols in place to monitor the prescribing of clozapine for adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs (at least 1 of which should be a non‑clozapine second‑generation antipsychotic).

Healthcare professionals ensure that adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs (at least 1 of which should be a non‑clozapine second‑generation antipsychotic) are offered clozapine.

Commissioners (such as NHS England area teams and clinical commissioning groups) monitor rates of prescribing of clozapine and commission services only from providers who can demonstrate that they have procedures and protocols in place to monitor this prescribing.

What the quality statement means for patients, service users and carers

Adults with schizophrenia that has not improved after treatment with at least 2 different antipsychotic drugs are offered an antipsychotic drug called clozapine to try and improve their symptoms.

Source guidance

Definitions of terms used in this quality statement

Schizophrenia that has not responded adequately to treatment

Schizophrenia that has not improved despite the sequential use of adequate doses of at least 2 different antipsychotic drugs. At least 1 of the drugs should be a non‑clozapine second‑generation antipsychotic. [Psychosis and schizophrenia in adults (NICE guideline CG178) recommendation 1.5.7.2]