Bradford District Care NHS Foundation Trust, Bradford, UK.
School of Pharmacy & Medical Sciences, University of Bradford, Bradford, UK.
J Psychopharmacol. 2024 Apr;38(4):382-394. doi: 10.1177/02698811241238283. Epub 2024 Mar 17.
Prescribing drugs for psychosis (antipsychotics) is challenging due to high rates of poor treatment outcomes, which are in part explained by an individual's genetics. Pharmacogenomic (PGx) testing can help clinicians tailor the choice or dose of psychosis drugs to an individual's genetics, particularly psychosis drugs with known variable response due to CYP2D6 gene variants ('CYP2D6-PGx antipsychotics').
This study aims to investigate differences between demographic groups prescribed 'CYP2D6-PGx antipsychotics' and estimate the proportion of patients eligible for PGx testing based on current pharmacogenomics guidance.
A cross-sectional study took place extracting data from 243 patients' medical records to explore psychosis drug prescribing, including drug transitions. Demographic data such as age, sex, ethnicity, and clinical sub-team were collected and summarised. Descriptive statistics explored the proportion of 'CYP2D6-PGx antipsychotic' prescribing and the nature of transitions. We used logistic regression analysis to investigate associations between demographic variables and prescription of 'CYP2D6-PGx antipsychotic' versus 'non-CYP2D6-PGx antipsychotic'.
Two-thirds (164) of patients had been prescribed a 'CYP2D6-PGx antipsychotic' (aripiprazole, risperidone, haloperidol or zuclopenthixol). Over a fifth (23%) of patients would have met the suggested criteria for PGx testing, following two psychosis drug trials. There were no statistically significant differences between age, sex, or ethnicity in the likelihood of being prescribed a 'CYP2D6-PGx antipsychotic'.
This study demonstrated high rates of prescribing 'CYP2D6-PGx-antipsychotics' in an EIP cohort, providing a rationale for further exploration of how PGx testing can be implemented in EIP services to personalise the prescribing of drugs for psychosis.
由于治疗效果不佳的比例较高，为精神病患者（抗精神病药）开处方具有挑战性，而部分原因是个体的遗传因素。药物基因组学（PGx）测试可以帮助临床医生根据个体的遗传因素选择或调整精神病药物的剂量，特别是对于由于 CYP2D6 基因突变而导致反应存在差异的精神病药物（“CYP2D6-PGx 抗精神病药”）。
本研究旨在调查开处方“CYP2D6-PGx 抗精神病药”的不同人群之间的差异，并根据当前的药物基因组学指南估计有资格进行 PGx 测试的患者比例。
进行了一项横断面研究，从 243 名患者的病历中提取数据，以探讨精神病药物的开方情况，包括药物转换。收集并总结了人口统计学数据，如年龄、性别、种族和临床亚组。描述性统计分析探索了“CYP2D6-PGx 抗精神病药”处方的比例以及转换的性质。我们使用逻辑回归分析来研究人口统计学变量与“CYP2D6-PGx 抗精神病药”与“非 CYP2D6-PGx 抗精神病药”处方之间的关联。
三分之二（164 名）的患者开了“CYP2D6-PGx 抗精神病药”（阿立哌唑、利培酮、氟哌啶醇或齐拉西酮）。在进行了两次精神病药物试验后，有超过五分之一（23%）的患者符合 PGx 测试的建议标准。在开“CYP2D6-PGx 抗精神病药”的可能性方面，年龄、性别或种族之间没有统计学上的显著差异。
本研究表明，在 EIP 队列中，CYP2D6-PGx 抗精神病药的处方率很高，这为进一步探索如何在 EIP 服务中实施 PGx 测试以个性化精神病药物的处方提供了依据。
