Karina Erlianti, Mohammed Alfaqeeh, Irma Melyani Puspitasari, Fredrick Dermawan Purba, Auliya A Suwantika
Clinically stable outpatients with TRS receiving clozapine-based therapy demonstrated favorable HRQoL, although impairments persisted in psychological well-being and daily functioning. Treatment regimen remained associated with both HRQoL measures after adjustment. These findings represent associations rather than causal effects and support individualized treatment selection, monitoring of treatment burden, and integration of psychosocial interventions.
BACKGROUND: Treatment-resistant schizophrenia (TRS) is associated with impairment and reduced health-related quality of life (HRQoL). Although clozapine is the standard treatment for TRS, evidence regarding HRQoL across clozapine-based regimens in low- and middle-income settings remains limited. This study evaluated HRQoL among clinically stable outpatients with TRS receiving clozapine-based therapy in Indonesia.
METHODS: A cross-sectional study was conducted at the mental hospital between November 2024 and January 2025. Participants (n = 147) received clozapine as monotherapy or in combination with first-generation antipsychotics (FGAs), second-generation antipsychotics (SGAs), or both. HRQoL was assessed using the Indonesian EQ-5D-5L and EQ-VAS. Differences across regimens were assessed using the Kruskal-Wallis test, followed by Mann-Whitney U pairwise comparisons with Bonferroni correction. Spearman's rank correlation assessed the association between EQ-5D-5L utility and EQ-VAS. Adjusted general linear models examined associations between treatment regimen and HRQoL after accounting for sociodemographic and characteristics.
RESULTS: Mean EQ-5D-5L utility and EQ-VAS scores were 0.804 ± 0.10 and 73.64 ± 9.46. Mobility was the least affected domain (95.2% reporting no problems), whereas impairment was observed in usual activities and anxiety/depression. EQ-5D-5L utility was positively correlated with EQ-VAS (Spearman's ρ = 0.606, p < 0.001). Both utility and EQ-VAS differed across treatment regimens (both p < 0.001), with the clozapine + FGA group showing the lowest scores. After adjustment, treatment regimen remained associated with utility (p = 0.002) and EQ-VAS (p < 0.001).
CONCLUSION: Clinically stable outpatients with TRS receiving clozapine-based therapy demonstrated favorable HRQoL, although impairments persisted in psychological well-being and daily functioning. Treatment regimen remained associated with both HRQoL measures after adjustment. These findings represent associations rather than causal effects and support individualized treatment selection, monitoring of treatment burden, and integration of psychosocial interventions.