Using pharmacogenetic data on metabolism status to guide antipsychotic prescribing for schizophrenia patients does not appear to improve symptoms or reduce side effects better than routine monitoring, according to a study published today in JAMA Network Open.
Gesche Jürgens, M.D., Ph.D., of Zealand University Hospital in Roskilde, Denmark, and colleagues conducted a clinical trial involving 311 adults diagnosed with schizophrenia. The participants were screened to see which variants of the drug-metabolizing cytochrome P450 (CYP) enzymes they had; based on their pharmacogenetic profile, they were classified as poor drug metabolizers, intermediate metabolizers, extensive metabolizers, or ultrarapid metabolizers.
The participants were then randomly assigned to one of three treatment groups. In the CYP-guided group, the attending psychiatrists were given the patient’s pharmacogenetic results to guide medication choice and dosing strategy. In the structured clinical monitoring group, the patients’ primary clinical contact (such as a nurse or social workers) was not given CYP results, but at least once every three months, they systemically assessed the patient’s symptoms, medication adherence, and side effects. For the routine care group, the patients’ CYP results were not shared, and patients were not required to undergo symptom assessment on a fixed schedule.
After one year, there was no difference in antipsychotic persistence among patients in the three groups; that is, the length of time that elapsed before patients’ medication or dose had to be changed. There was also no difference in antipsychotic persistence when only examining patients with extreme metabolism (either poor or ultrarapid metabolizers). Additionally, the groups were similar in terms of total improvements in patients’ hallucination or delusion symptoms and the frequency of adverse side effects.
“As a holistic approach, clinical monitoring can detect adverse effects and treatment failure, even when they are unrelated to the patient’s drug metabolism. In contrast, CYP genotyping mainly serves to identify patients at risk of relative underdosage or overdosage due to abnormal drug metabolism,” they authors wrote. “These results do not support routine use of genotyping for CYP2D6 and CYP2C19 polymorphisms in patients with schizophrenia.”
To read more on this topic, see the Psychiatric News article “Pharmacogenomic Tests in Psychiatry: Not Ready for Prime Time.”
(Image: iStock/cosmin4000)
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