Abstract
Using pharmacogenetics in guiding drug therapy experiences a steady increase in uptake, although still leads to discussions as to its clinical use. Psychiatry constitutes a field where pharmacogenomic testing might help in guiding drug therapy. To address current challenges, this minireview provides an update regarding genotyping (SNP analysis/arrays/NGS), structural variant detection (star-alleles/CNVs/hybrid alleles), genotype-to-phenotype translations, cost-effectiveness, and actionability of results (FDA/CPIC/PharmGKB) regarding clinical importance of pre-emptive pharmacogenomic testing for prescription of antidepressants and antipsychotics.
Highlights
Regarding DNA testing for guiding drug therapy, the value of CYP2D6 and CYP2C19 genotyping for optimizing drug treatment in psychiatry has been a focus point
The incidence of switching of risperidone to another antipsychotic was significantly higher in CYP2D6 ultra-rapid metabolizers (OR, 2.9; 95% CI, 1.4–6.0; p = 0.003) and for CYP2D6 poor metabolizers (OR, 1.9; 95% CI, 1.1–3.1; p = 0.015), indicating that, at least for risperidone, CYP2D6 genotype status has a clinical impact
FDA published in 2020 a Table of Pharmacogenetic Associations5, distinguishing three different categories: (a) pharmacogenetic associations for which data support therapeutic management recommendations, (b) pharmacogenetic associations for which data indicate a potential impact on safety or response, and c) pharmacogenetic associations for which data demonstrate a potential impact on pharmacokinetic properties only
Summary
Regarding DNA testing for guiding drug therapy, the value of CYP2D6 and CYP2C19 genotyping for optimizing drug treatment in psychiatry has been a focus point. >200 drugs are available for treatment of psychiatric/neurologic patients (Hiemke et al, 2018). Use of this medication is hampered by side-effects and lack of effectivity, leaving therapeutic outcomes nonsatisfactory. Several evidence-based dosing guidelines for using pharmacogenetics for antidepressants/ antipsychotics have been published (Swen et al, 2008; Swen et al, 2011; Hicks et al, 2013; Hicks et al, 2017). This minireview addresses the latest developments in pharmacogenetics for psychiatry and discusses some challenges to be faced in the near future
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