AssureRx Health , Mason, Ohio.
Int Rev Psychiatry. 2013 Oct;25(5):509-33. doi: 10.3109/09540261.2013.825579.
Adverse events, response failures and medication non-compliance are common in patients receiving medications for the treatment of mental illnesses. A systematic literature review assessed whether pharmacokinetic (PK) or pharmacodynamic (PD) responses to 26 commonly prescribed antipsychotic and antidepressant medications, including efficacy or side effects, are associated with nucleotide polymorphisms in eight commonly studied genes in psychiatric pharmacotherapy: CYP2D6, CYP2C19, CYP2C9, CYP1A2, CYP3A4, HTR2C, HTR2A, and SLC6A4. Of the 294 publications included in this review, 168 (57%) showed significant associations between gene variants and PK or PD outcomes. Other studies that showed no association often had insufficient control for confounding variables, such as co-medication use, or analysis of medications not substrates of the target gene. The strongest gene-outcome associations were for the PK profiles of CYP2C19 and CYP2D6 (93% and 90%, respectively), for the PD associations between HTR2C and weight gain (57%), and for SLC6A4 and clinical response (54%), with stronger SLC6A4 response associations for specific drug classes (60-83%). The preponderance of evidence supports the validity of analyzing nucleotide polymorphisms in CYP and pharmacodynamic genes to predict the metabolism, safety, or therapeutic efficacy of psychotropic medications commonly used for the treatment of depression, schizophrenia, and bipolar illness.
在接受精神疾病药物治疗的患者中，不良事件、反应失败和药物依从性差很常见。一项系统文献综述评估了 26 种常用抗精神病药和抗抑郁药的药代动力学（PK）或药效学（PD）反应，包括疗效或副作用，是否与精神药理学治疗中八个常用基因的核苷酸多态性有关：CYP2D6、CYP2C19、CYP2C9、CYP1A2、CYP3A4、HTR2C、HTR2A 和 SLC6A4。在本综述中包含的 294 篇出版物中，有 168 篇（57%）显示基因变异与 PK 或 PD 结果之间存在显著关联。其他显示无关联的研究通常没有充分控制混杂变量，如合并用药或分析非目标基因底物的药物。与 PK 结果关联最强的基因是 CYP2C19 和 CYP2D6（分别为 93%和 90%），与 PD 结果关联最强的基因是 HTR2C 与体重增加（57%），与 SLC6A4 与临床反应（54%），特定药物类别（60-83%）的 SLC6A4 反应关联更强。大量证据支持分析 CYP 和药效学基因中的核苷酸多态性，以预测常用于治疗抑郁症、精神分裂症和双相情感障碍的精神药物的代谢、安全性或治疗效果。
