Unidentified CYP2D6 genotype does not affect pharmacological treatment for patients with first episode psychosis

Emma Y. De Brabander*, Therese van Amelsvoort, Roos van Westrhenen, Genetic Risk and Outcome of Psychosis (GROUP) Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Research on the pharmacogenetic influence of hepatic CYP450 enzyme 2D6 (CYP2D6) on metabolism of drugs for psychosis and associated outcome has been inconclusive. Some results suggest increased risk of adverse reactions in poor and intermediate metabolizers, while others find no relationship. However, retrospective designs may fail to account for the long-term pharmacological treatment of patients. Previous studies found that clinicians adapted risperidone dose successfully without knowledge of patient CYP2D6 phenotype. Aim: Here, we aimed to replicate the results of those studies in a Dutch cohort of patients with psychosis (N = 418) on pharmacological treatment. Method: We compared chlorpromazine-equivalent dose between CYP2D6 metabolizer phenotypes and investigated which factors were associated with dosage. This was repeated in two smaller subsets; patients prescribed pharmacogenetics-actionable drugs according to published guidelines, and risperidone-only as done previously. Results: We found no relationship between chlorpromazine-equivalent dose and phenotype in any sample (complete sample: p = 0.3, actionable-subset: p = 0.82, risperidone-only: p = 0.34). Only clozapine dose was weakly associated with CYP2D6 phenotype (p = 0.03). Conclusion: Clinicians were thus not intuitively adapting dose to CYP2D6 activity in this sample, nor was CYP2D6 activity associated with prescribed dose. Although the previous studies could not be replicated, this study may provide support for existing and future pharmacogenetic research.
Original languageEnglish
Pages (from-to)1111-1121
Number of pages11
JournalJournal of Psychopharmacology
Volume38
Issue number12
Early online date2024
DOIs
Publication statusPublished - 1 Dec 2024

Keywords

  • Pharmacogenetics
  • drugs for psychosis
  • psychosis
  • CYP2D6
  • GENE-ENVIRONMENT INTERACTION
  • SYNDROME SCALE PANSS
  • SELF-REPORT
  • ANTIPSYCHOTICS
  • SCHIZOPHRENIA
  • PHARMACOGENETICS
  • TEMPERAMENTS
  • MEDICATION
  • EFFICACY
  • POLYMORPHISM

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