Murphy Lara E, Fonseka Trehani M, Bousman Chad A, Müller Daniel J
Pharmacogenetics Research Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Mol Psychiatry. 2022 Jan;27(1):593-605. doi: 10.1038/s41380-021-01340-6. Epub 2021 Nov 9.
Substantial inter-individual discrepancies exist in both therapeutic effectiveness and adverse effects of antidepressant and antipsychotic medications, which can, in part, be explained by genetic variation. Here, we searched the Pharmacogenomics Knowledge Base for gene-antidepressant and gene-antipsychotic pairs with the highest level of evidence. We then extracted and compared the associated prescribing recommendations for these pairs developed by the Clinical Pharmacogenomics Implementation Consortium, the Dutch Pharmacogenetics Working Group or approved product labels in the US, Canada, Europe, and Asia. Finally, we highlight key economical, educational, regulatory, and ethical issues that, if not appropriately considered, can hinder the implementation of these recommendations in clinical practice. Our review indicates that evidence-based guidelines are available to assist with the implementation of pharmacogenetic-guided antidepressant and antipsychotic prescribing, although the maximum impact of these guidelines on patient care will not be realized until key barriers are minimized or eliminated.
抗抑郁药和抗精神病药物的治疗效果和不良反应在个体间存在很大差异，部分原因可由基因变异来解释。在此，我们在药物基因组学知识库中搜索了证据水平最高的基因-抗抑郁药和基因-抗精神病药物对。然后，我们提取并比较了临床药物基因组学实施联盟、荷兰药物遗传学工作组或美国、加拿大、欧洲和亚洲批准的产品标签针对这些药物对制定的相关处方建议。最后，我们强调了一些关键的经济、教育、监管和伦理问题，如果这些问题得不到妥善考虑，可能会阻碍这些建议在临床实践中的实施。我们的综述表明，有基于证据的指南可协助实施药物遗传学指导的抗抑郁药和抗精神病药物处方，但在将关键障碍降至最低或消除之前，这些指南对患者护理的最大影响将无法实现。
