Cargando…

G-CSF mediated neutrophil augmentation in a unique case of comorbid idiopathic Parkinson’s disease and treatment-resistant schizophrenia on clozapine

Treatment of psychosis in Parkinson’s disease (PD) is challenging; pharmacological options are limited, with clozapine considered most effective. The risk of agranulocytosis restricts the use of clozapine, but, where this occurs, cautious re-challenge with granulocyte stimulating factor can be succe...

Descripción completa

Detalles Bibliográficos
Autores principales: Morrow, Olivia, Gibson, Lucy, Bhamra, Manraj, David, Anthony S., Posporelis, Sotirios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498832/
https://www.ncbi.nlm.nih.gov/pubmed/32973999
http://dx.doi.org/10.1177/2045125320956414
_version_ 1783583597465174016
author Morrow, Olivia
Gibson, Lucy
Bhamra, Manraj
David, Anthony S.
Posporelis, Sotirios
author_facet Morrow, Olivia
Gibson, Lucy
Bhamra, Manraj
David, Anthony S.
Posporelis, Sotirios
author_sort Morrow, Olivia
collection PubMed
description Treatment of psychosis in Parkinson’s disease (PD) is challenging; pharmacological options are limited, with clozapine considered most effective. The risk of agranulocytosis restricts the use of clozapine, but, where this occurs, cautious re-challenge with granulocyte stimulating factor can be successful. We present a unique case of a patient who developed early-onset PD on a background of antecedent treatment-resistant schizophrenia, who had been treated effectively with clozapine for over 15 years with no adverse events. However, during a hospital admission intended to optimise her Parkinsonian medications, she developed persistent neutropenia necessitating clozapine discontinuation. Numerous attempts to re-challenge with clozapine failed until augmentation with lithium and G-CSF was trialled. Two doses of G-CSF led to a sustained increase in the neutrophil count, allowing the continuation of clozapine therapy in the 1 year of follow up. This illustrates the potential for G-CSF to be used to facilitate clozapine use in a patient population not described previously. Neutrophil augmentation allowed the sustained continuation of this effective therapy, treating her psychotic symptoms without detriment to her movement disorder. We suggest that G-CSF might be considered as a treatment option in other cases where clozapine-associated neutropenia obstructs its use.
format Online
Article
Text
id pubmed-7498832
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-74988322020-09-23 G-CSF mediated neutrophil augmentation in a unique case of comorbid idiopathic Parkinson’s disease and treatment-resistant schizophrenia on clozapine Morrow, Olivia Gibson, Lucy Bhamra, Manraj David, Anthony S. Posporelis, Sotirios Ther Adv Psychopharmacol Case Report Treatment of psychosis in Parkinson’s disease (PD) is challenging; pharmacological options are limited, with clozapine considered most effective. The risk of agranulocytosis restricts the use of clozapine, but, where this occurs, cautious re-challenge with granulocyte stimulating factor can be successful. We present a unique case of a patient who developed early-onset PD on a background of antecedent treatment-resistant schizophrenia, who had been treated effectively with clozapine for over 15 years with no adverse events. However, during a hospital admission intended to optimise her Parkinsonian medications, she developed persistent neutropenia necessitating clozapine discontinuation. Numerous attempts to re-challenge with clozapine failed until augmentation with lithium and G-CSF was trialled. Two doses of G-CSF led to a sustained increase in the neutrophil count, allowing the continuation of clozapine therapy in the 1 year of follow up. This illustrates the potential for G-CSF to be used to facilitate clozapine use in a patient population not described previously. Neutrophil augmentation allowed the sustained continuation of this effective therapy, treating her psychotic symptoms without detriment to her movement disorder. We suggest that G-CSF might be considered as a treatment option in other cases where clozapine-associated neutropenia obstructs its use. SAGE Publications 2020-09-16 /pmc/articles/PMC7498832/ /pubmed/32973999 http://dx.doi.org/10.1177/2045125320956414 Text en © The Author(s), 2020 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Case Report
Morrow, Olivia
Gibson, Lucy
Bhamra, Manraj
David, Anthony S.
Posporelis, Sotirios
G-CSF mediated neutrophil augmentation in a unique case of comorbid idiopathic Parkinson’s disease and treatment-resistant schizophrenia on clozapine
title G-CSF mediated neutrophil augmentation in a unique case of comorbid idiopathic Parkinson’s disease and treatment-resistant schizophrenia on clozapine
title_full G-CSF mediated neutrophil augmentation in a unique case of comorbid idiopathic Parkinson’s disease and treatment-resistant schizophrenia on clozapine
title_fullStr G-CSF mediated neutrophil augmentation in a unique case of comorbid idiopathic Parkinson’s disease and treatment-resistant schizophrenia on clozapine
title_full_unstemmed G-CSF mediated neutrophil augmentation in a unique case of comorbid idiopathic Parkinson’s disease and treatment-resistant schizophrenia on clozapine
title_short G-CSF mediated neutrophil augmentation in a unique case of comorbid idiopathic Parkinson’s disease and treatment-resistant schizophrenia on clozapine
title_sort g-csf mediated neutrophil augmentation in a unique case of comorbid idiopathic parkinson’s disease and treatment-resistant schizophrenia on clozapine
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498832/
https://www.ncbi.nlm.nih.gov/pubmed/32973999
http://dx.doi.org/10.1177/2045125320956414
work_keys_str_mv AT morrowolivia gcsfmediatedneutrophilaugmentationinauniquecaseofcomorbididiopathicparkinsonsdiseaseandtreatmentresistantschizophreniaonclozapine
AT gibsonlucy gcsfmediatedneutrophilaugmentationinauniquecaseofcomorbididiopathicparkinsonsdiseaseandtreatmentresistantschizophreniaonclozapine
AT bhamramanraj gcsfmediatedneutrophilaugmentationinauniquecaseofcomorbididiopathicparkinsonsdiseaseandtreatmentresistantschizophreniaonclozapine
AT davidanthonys gcsfmediatedneutrophilaugmentationinauniquecaseofcomorbididiopathicparkinsonsdiseaseandtreatmentresistantschizophreniaonclozapine
AT posporelissotirios gcsfmediatedneutrophilaugmentationinauniquecaseofcomorbididiopathicparkinsonsdiseaseandtreatmentresistantschizophreniaonclozapine