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Role of cytokine changes in clozapine‐induced fever: A cohort prospective study
Author(s) -
Hung YuanPin,
Wang Carol SM.,
Yen ChiaNan,
Chang HsunCheng,
Chen Po See,
Lee I Hui,
Chen Kao Chin,
Yang Yen Kuang,
Lu RuBand,
Wang TzuYun
Publication year - 2017
Publication title -
psychiatry and clinical neurosciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.609
H-Index - 74
eISSN - 1440-1819
pISSN - 1323-1316
DOI - 10.1111/pcn.12508
Subject(s) - clozapine , prospective cohort study , cytokine , medicine , cohort study , psychology , psychiatry , immunology , schizophrenia (object oriented programming)
Aim Clozapine‐associated fever is common but the specific cytokine changes and treatment durations that may cause fever remain unknown. We investigated the association between inflammatory cytokine changes and clozapine‐induced fever in patients who were treated with clozapine. Methods Forty‐three patients with schizophrenia or schizoaffective disorder, diagnosed by using the Chinese Version of the Mini International Neuropsychiatric Interview, were treated with clozapine for the first time (first‐time use group, n = 22) or for more than 6 months (long‐term use group, n = 21). The Positive and Negative Syndrome Scale, tympanic temperature, and levels of tumor necrosis factor‐α ( TNF ‐α), interferon‐γ ( INF ‐γ), interleukin‐2 ( IL ‐2), and interleukin‐6 ( IL ‐6) were determined at baseline and weeks 1, 2, 3, 4, and 6. A multiple linear regression with generalized estimating equation methods was used to analyze the association between the changes in the cytokine levels and clozapine‐induced fever in the different groups. Results The IL ‐6 level changes were significantly different between the two groups ( P = 0.04). In the first‐time use group, the fever rate was increased (47.1%) compared with the long‐term use group (5.6%, P = 0.005). Moreover, in these patients, the TNF ‐α, INF ‐γ, IL ‐2, and IL ‐6 levels were significantly ( P < 0.001) different from patients who did not develop a fever. An interaction effect with the different treatment duration groups and fever development was only significant for IL ‐6 ( P < 0.001). Conclusion Patients who were treated with clozapine for the first time have an increased rate of developing a fever, and IL ‐6 might have a specific role in the interaction effect between treatment duration and fever development.