Clozapine is the most effective medication for treatment-resistant psychoses, but the balance of benefits and risks is understudied in real-world settings.

To examine the relative re-hospitalisation rates for mental health relapse and adverse events associated with clozapine and other antipsychotics in adult and child/youth cohorts.

Data were obtained from the Canadian Institute of Health Information for adults (n = 45 616) and children/youth (n = 1476) initially hospitalised for mental health conditions in British Columbia, Manitoba and Saskatchewan from 2008 to 2018. Patient demographics and hospitalisations were linked with antipsychotic prescriptions dispensed following the initial visit. Recurrent events survival analysis for relapse and adverse events were created and compared between clozapine and other antipsychotics.

In adults, clozapine was associated with a 14% lower relapse rate versus other drugs (adjusted hazard ratio: 0.86, 95% CI: 0.83–0.90) over the 10-year follow-up. In the first 21 months, the relapse rate was higher for clozapine but then reversed. Over 1000 person-months, clozapine-treated adults could be expected to have 38 relapse hospitalisations compared with 45 for other drugs. In children/youth, clozapine had a 38% lower relapse rate compared with other antipsychotic medications (adjusted hazard ratio: 0.62, 95% CI: 0.49–0.78) over the follow-up period. This equates to 29 hospitalisations for clozapine and 48 for other drugs over 1000 person-months. In adults, clozapine had a higher risk for adverse events (hazard ratio: 1.34, 95% CI: 1.18–1.54) over the entire follow-up compared with other antipsychotics. This equates to 1.77 and 1.30 hospitalisations over 1000 person-months for clozapine and other drugs, respectively.

Clozapine was associated with lower relapse overall, but this was accompanied by higher adverse events for adults. For children/youth, clozapine was associated with lower relapse all throughout and had no difference in adverse events compared with other antipsychotics.

氯氮平是治疗难治性精神病最有效的药物，但在现实环境中，其益处和风险的平衡尚未得到充分研究。

研究成人和儿童/青少年队列中与氯氮平和其他抗精神病药物相关的心理健康复发和不良事件的相对再住院率。

数据来自加拿大健康信息研究所，收集了 2008 年至 2018 年不列颠哥伦比亚省、马尼托巴省和萨斯喀彻温省最初因精神健康问题住院的成人 ( n = 45 616) 和儿童/青少年 ( n = 1476) 的数据。与初次就诊后开出的抗精神病药物处方相关。创建了复发和不良事件的复发事件生存分析，并在氯氮平和其他抗精神病药物之间进行了比较。

在成人中，10 年随访期间，氯氮平与其他药物相比，复发率降低 14%（调整后风险比：0.86，95% CI：0.83-0.90）。在前 21 个月，氯氮平的复发率较高，但随后又出现逆转。在超过 1000 人月的时间里，接受氯氮平治疗的成年人预计会有 38 人复发住院，而使用其他药物的则为 45 人。在儿童/青少年中，与其他抗精神病药物相比，氯氮平在随访期间的复发率降低了 38%（调整后风险比：0.62，95% CI：0.49-0.78）。这相当于超过 1000 人月有 29 人因氯氮平住院，48 人因其他药物住院。在成人中，与其他抗精神病药物相比，氯氮平在整个随访期间发生不良事件的风险较高（风险比：1.34，95% CI：1.18-1.54）。这相当于 1000 人月因氯氮平和其他药物分别导致 1.77 和 1.30 人住院。

氯氮平总体上与较低的复发率相关，但这伴随着成人不良事件的增加。对于儿童/青少年来说，氯氮平与其他抗精神病药物相比，总体复发率较低，并且不良事件没有差异。