Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN.
Vanderbilt Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN.
Ethn Dis. 2020 Apr 2;30(Suppl 1):229-240. doi: 10.18865/ed.30.S1.229. eCollection 2020.
Management of schizophrenia among Blacks in the United States is affected by persistent disparities. This review explored response to atypical antipsychotics among Blacks compared with other groups to assess systematic variation that may contribute to disparities.
We conducted a quasi-systematic review of studies reporting response to atypical antipsychotics among Blacks compared with other groups, including effects of genetic variation.
Of 48 identified research articles, 29 assessed differences in outcomes without inclusion of genetic variation and 20 explored effects of genetic variation; of note: one article included both types of data. Analysis of the 29 papers with clinical outcomes only suggests that while data on efficacy and risk of movement disorders were heterogeneous, findings indicate increased risk of metabolic effects and neutropenia among Blacks. Of the 20 articles exploring effects of genetic variation, allelic or genotypic variations involving several genes were associated with altered efficacy or safety among Blacks but not Whites, including risk of decreased response involving variation in and , and improved efficacy associated with variants in , , and . Others showed significant improvement in treatment response only among Whites, including variation in , , and .
The current analysis can help tailor management among Blacks using an atypical antipsychotic. Heterogeneity in genetic variation effects and response allele frequency suggests that pharmacogenetics approaches for atypical antipsychotics will need to explicitly incorporate race and ethnicity.
美国黑人群体中精神分裂症的管理受到持续存在的差异的影响。本综述探讨了与其他群体相比，黑人对非典型抗精神病药物的反应，以评估可能导致差异的系统差异。
我们对报告黑人与其他群体相比对非典型抗精神病药物反应的研究进行了准系统综述，包括遗传变异的影响。
在确定的 48 篇研究文章中，有 29 篇评估了结果差异，没有纳入遗传变异，有 20 篇探讨了遗传变异的影响；值得注意的是：有一篇文章同时包含了这两种类型的数据。仅对具有临床结果的 29 篇论文进行分析表明，虽然关于疗效和运动障碍风险的数据存在异质性，但研究结果表明黑人患代谢副作用和中性粒细胞减少症的风险增加。在探索遗传变异影响的 20 篇文章中，涉及几个基因的等位基因或基因型变异与黑人而非白人的疗效或安全性改变有关，包括涉及 和 变异的反应降低风险，以及与 、 和 变异相关的疗效改善。其他人仅显示出对白人的治疗反应有显著改善，包括涉及 、 和 变异的情况。
目前的分析可以帮助针对黑人使用非典型抗精神病药物进行个性化治疗。遗传变异效应和反应等位基因频率的异质性表明，非典型抗精神病药物的药物遗传学方法将需要明确纳入种族和民族。
