Optimisation of pharmacotherapy in psychiatry through therapeutic drug monitoring, molecular brain imaging and pharmacogenetic tests: focus on antipsychotics.

Journal

The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry
ISSN: 1814-1412
Titre abrégé: World J Biol Psychiatry
Pays: England
ID NLM: 101120023

Informations de publication

Date de publication:
24 Jun 2024
Historique:
medline: 24 6 2024
pubmed: 24 6 2024
entrez: 24 6 2024
Statut: aheadofprint

Résumé

For psychotic disorders (i.e. schizophrenia), pharmacotherapy plays a key role in controlling acute and long-term symptoms. To find the optimal individual dose and dosage strategy, specialized tools are used. Three tools have been proven useful to personalize drug treatments: therapeutic drug monitoring (TDM) of drug levels, pharmacogenetic testing (PG), and molecular neuroimaging. In these Guidelines, we provide an in-depth review of pharmacokinetics, pharmacodynamics, and pharmacogenetics for 50 antipsychotics. Over 30 international experts in psychiatry selected studies that have measured drug concentrations in the blood (TDM), gene polymorphisms of enzymes involved in drug metabolism, or receptor/transporter occupancies in the brain (positron emission tomography (PET)). Study results strongly support the use of TDM and the cytochrome P450 (CYP) genotyping and/or phenotyping to guide drug therapies. Evidence-based target ranges are available for titrating drug doses that are often supported by PET findings. All three tools discussed in these Guidelines are essential for drug treatment. TDM goes well beyond typical indications such as unclear compliance and polypharmacy. Despite its enormous potential to optimize treatment effects, minimize side effects and ultimately reduce the global burden of diseases, personalized drug treatment has not yet become the standard of care in psychiatry.

Sections du résumé

BACKGROUND BACKGROUND
For psychotic disorders (i.e. schizophrenia), pharmacotherapy plays a key role in controlling acute and long-term symptoms. To find the optimal individual dose and dosage strategy, specialized tools are used. Three tools have been proven useful to personalize drug treatments: therapeutic drug monitoring (TDM) of drug levels, pharmacogenetic testing (PG), and molecular neuroimaging.
METHODS METHODS
In these Guidelines, we provide an in-depth review of pharmacokinetics, pharmacodynamics, and pharmacogenetics for 50 antipsychotics. Over 30 international experts in psychiatry selected studies that have measured drug concentrations in the blood (TDM), gene polymorphisms of enzymes involved in drug metabolism, or receptor/transporter occupancies in the brain (positron emission tomography (PET)).
RESULTS RESULTS
Study results strongly support the use of TDM and the cytochrome P450 (CYP) genotyping and/or phenotyping to guide drug therapies. Evidence-based target ranges are available for titrating drug doses that are often supported by PET findings.
CONCLUSION CONCLUSIONS
All three tools discussed in these Guidelines are essential for drug treatment. TDM goes well beyond typical indications such as unclear compliance and polypharmacy. Despite its enormous potential to optimize treatment effects, minimize side effects and ultimately reduce the global burden of diseases, personalized drug treatment has not yet become the standard of care in psychiatry.

Identifiants

DOI: 10.1080/15622975.2024.2366235 PMID: 38913780
pubmed: 38913780
doi: 10.1080/15622975.2024.2366235
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1-123

Auteurs

X M Hart (XM)

Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.

G Gründer (G)

Central Institute of Mental Health, Department of Molecular Neuroimaging, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
German Center for Mental Health (DZPG), partner site Mannheim - Heidelberg - Ulm.

N Ansermot (N)

Unit of Pharmacogenetics and Clinical Psychopharmacology, Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland.

A Conca (A)

Dipartimento di Psichiatria, Comprensorio Sanitario di Bolzano, Bolzano, Italy.

E Corruble (E)

Université Paris-Saclay, AP-HP, Service Hospitalo-Universitaire de Psychiatrie, Hôpital de Bicêtre.
Equipe MOODS, Inserm U1018, CESP (Centre de Recherche en Epidémiologie et Sante des Populations), Le Kremlin-Bicêtre, France.

S Crettol (S)

Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland.

P Cumming (P)

Department of Nuclear Medicine, Bern University Hospital, Bern, Switzerland.
School of Psychology and Counseling, Queensland University of Technology, Brisbane, Australia.

G Hefner (G)

Vitos Clinic for Forensic Psychiatry, Forensic Psychiatry, Eltville, Germany.

A Frajerman (A)

Université Paris-Saclay, AP-HP, Service Hospitalo-Universitaire de Psychiatrie, Hôpital de Bicêtre.
Equipe MOODS, Inserm U1018, CESP (Centre de Recherche en Epidémiologie et Sante des Populations), Le Kremlin-Bicêtre, France.

O Howes (O)

Department of Psychosis Studies, IoPPN, King's College London, De Crespigny Park, London, SE5 8AF, UK.
Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London W12 0NN, UK.
ORCID: 0000-0002-2928-1972

M Jukic (M)

Department of Physiology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia and Pharmacogenetics Section, Department of Physiology and Pharmacology, Karolinska Institutet, Solna, Sweden.

E Kim (E)

Department of Psychiatry, Seoul National University College of Medicine, Republic of Korea.

S Kim (S)

Department of Neuropsychiatry, Seoul National University Bundang Hospital, Republic of Korea.

I Manisalco (I)

Dipartimento di Psichiatria, Comprensorio Sanitario di Bolzano, Bolzano, Italy.

S Moriguchi (S)

Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.

D J Müller (DJ)

Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.
Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.

S Nakajima (S)

Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.

M Osugo (M)

Department of Psychosis Studies, IoPPN, King's College London, De Crespigny Park, London, SE5 8AF, UK.
Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, Du Cane Road, London W12 0NN, UK.

M Paulzen (M)

Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University.
JARA - Translational Brain Medicine, Aachen, Germany; Alexianer Center for Mental Health, Aachen, Germany.

H G Ruhe (HG)

Department of psychiatry, Radboudumc, Nijmegen, Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands.

M Scherf-Clavel (M)

Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.

G Schoretsanitis (G)

Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland.
ORCID: 0000-0002-3851-4117

A Serretti (A)

Department of Medicine and Surgery, Kore University of Enna, Italy.
ORCID: 0000-0003-4363-3759

E Spina (E)

Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.

O Spigset (O)

Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway, and Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

W Steimer (W)

Institute of Clinical Chemistry and Pathobiochemistry, Technical University Munich, Munich, Germany.

H S Süzen (HS)

Department of Pharmaceutic Toxicology, Faculty of Pharmacy, Ankara University, Ankara, Turkey.

H Uchida (H)

Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.

S Unterecker (S)

Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.

F Vandenberghe (F)

Unit of Pharmacogenetics and Clinical Psychopharmacology, Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland.

C Verstuyft (C)

Department of Molecular Genetics, Pharmacogenetics and Hormonology Bicêtre University Hospital Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, F-94275, France.
CESP, MOODS Team, INSERM UMR 1018, Medicine Faculty, Paris-Saclay University, Le Kremlin Bicêtre, France.

G Zernig (G)

Department of Pharmacology, Medical University Innsbruck; Private Practice for Psychotherapy and Court-Certified Witness, Hall in Tirol, Austria.

C Hiemke (C)

Department of Psychiatry and Psychotherapy and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of Mainz, Germany.

C B Eap (CB)

Unit of Pharmacogenetics and Clinical Psychopharmacology, Department of Psychiatry, Centre for Psychiatric Neuroscience, Lausanne University Hospital, University of Lausanne, 1008 Prilly, Switzerland.
School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
Center for Research and Innovation in Clinical Pharmaceutical Sciences, University of Lausanne, Lausanne, Switzerland.
Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland.

Classifications MeSH