van Westrhenen R, van Schaik R H N, van Gelder T, Birkenhager T K, Bakker P R, Houwink E J F, Bet P M, Hoogendijk W J G, van Weelden-Hulshof M J M
Outpatient Clinic Pharmacogenetics in Psychiatry, Parnassia Group Amsterdam, Amsterdam, Netherlands.
Maastricht Department of Psychiatry andNeuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
Front Pharmacol. 2021 Apr 12;12:640032. doi: 10.3389/fphar.2021.640032. eCollection 2021.
Effective pharmacologic treatments for psychiatric disorders are available, but their effect is limited due to patients' genetic heterogeneity and low compliance-related to frequent adverse events. Only one third of patients respond to treatment and experience remission. Pharmacogenetics is a relatively young field which focusses on genetic analyses in the context of the metabolism and outcome of drug treatment. These genetic factors can, among other things, lead to differences in the activity of enzymes that metabolize drugs. Recently, a clinical guideline was authorized by the Dutch Clinical Psychiatric Association (NVvP) on the clinical use of pharmacogenetics in psychiatry. The main goal was to provide guidance, based on current evidence, on how to best use genotyping in clinical psychiatric practice. A systematic literature search was performed, and available publications were assessed using the GRADE methodology. General recommendations for psychiatric clinical practice were provided, and specific recommendations per medication were made available. This clinical guideline for caregivers prescribing psychotropic drugs is the product of a broad collaboration of professionals from different disciplines, making use of the information available at the Dutch Pharmacogenetics Working Group (DPWG) and the Clinical Pharmacogenetics Implementation Consortium (CPIC) so far. We summarize the relevant literature and all recommendations in this article. General recommendations are provided and also detailed recommendations per medication. In summary we advise to consider genotyping, when there are side effects or inefficacy for CYP2C19 and CYP2D6. When genotype information is available use this to select the right drug in the right dose for the right patient.
治疗精神疾病的有效药物是可用的，但由于患者的基因异质性以及与频繁不良事件相关的低依从性，其效果有限。只有三分之一的患者对治疗有反应并实现缓解。药物遗传学是一个相对较新的领域，专注于在药物治疗的代谢和结果背景下进行基因分析。这些遗传因素尤其会导致药物代谢酶活性的差异。最近，荷兰临床精神病学协会（NVvP）批准了一项关于药物遗传学在精神病学临床应用的临床指南。主要目标是根据现有证据，就如何在临床精神病学实践中最佳使用基因分型提供指导。进行了系统的文献检索，并使用GRADE方法对现有出版物进行了评估。提供了精神病学临床实践的一般建议，并针对每种药物给出了具体建议。这份为开具精神药物的护理人员制定的临床指南是来自不同学科的专业人员广泛合作的成果，充分利用了荷兰药物遗传学工作组（DPWG）和临床药物遗传学实施联盟（CPIC）目前可得的信息。我们在本文中总结了相关文献和所有建议。提供了一般建议以及针对每种药物的详细建议。总之，我们建议在出现CYP2C19和CYP2D6的副作用或无效情况时考虑进行基因分型。当有基因型信息可用时，利用它为合适的患者选择合适剂量的正确药物。
