Minimum Pharmacogenetics Testing Panel for Psychotropic Medication

13 Oct Minimum Pharmacogenetics Testing Panel for Psychotropic Medication

Bousman et al propose a minimum gene and allele set for pharmacogenetic testing in psychiatry that includes 16 variant alleles within five genes (CYP2C9, CYP2C19, CYP2D6, HLA-A,HLA-B).

Genotype-guided prescribing with pharmacogenetics helps clinicians choose the right medication or dose for each individual. The goal of using pharmacogenetics is to avoid trial and error by selecting safer medications and increasing the chance for effectiveness when a person starts a treatment. The technology is transforming antidepressant and antipsychotic treatment. Up to a third of patients with major depression do not fully respond to antidepressant treatment, and many experience serious adverse effects. Genetic variation may contribute to this differential risk to benefit ratio.

As the implementation of routine pharmacogenetic testing in the clinic is underway, Bousman et al summarized the current gene–drug interaction knowledgebase and proposed a minimum gene and allele set for pharmacogenetic testing in psychiatry. Based on the current scientific literature, drug labels, and pharmacogenetic-based implementation guidelines relevant to psychiatry, Pharmacogenomics Knowledgebase (PharmGKB) has cataloged 448 gene–drug interactions. A majority of these interactions involved two cytochrome P450 enzymes (CYP2D6 and CYP2C19) and antidepressant medications. CYP2C9, HLA-A, and HLA-B are relevant to mood stabilizers/anticonvulsants.

Take from Bousman C, Maruf AA, Müller DJ. 2018.

Bousman et al proposed a minimum gene and allele set for pharmacogenetic testing in psychiatry that includes 16 variant alleles within five genes (CYP2C9, CYP2C19, CYP2D6, HLA-A, HLA-B), on the basis of the highest levels of evidence. Their goal is to assist clinicians in judging the gene and allele content of pharmacogenetic tests and to facilitate pharmacogenetic testing as a standard protocol and companion tool for psychotropic medication selection and dosing.

Bousman C, Maruf AA, Müller DJ. 2018. Towards the integration of pharmacogenetics in psychiatry: a minimum, evidence-based genetic testing panel. Curr Opin Psychiatry