Pharmacogenetics of Antipsychotics: From CYP2D6 Dosing to Tardive Dyskinesia Risk Genes
This meta-review synthesises two decades of pharmacogenetic evidence for antipsychotic response and key adverse effects including weight gain, tardive dyskinesia, and clozapine-induced agranulocytosis. CYP2D6 metaboliser phenotypes have the strongest evidence base and are now embedded in product labels and CPIC/DPWG guidelines. Emerging associations with DRD2, SLC18A2, and HLA genes point toward future multigene panels for psychiatric prescribing.
The original study
Pharmacogenetics-Guided Advances in Antipsychotic Treatment.
- Authors
- Islam F, Men X, Yoshida K, Zai CC, Müller DJ
- Journal
- Clinical pharmacology and therapeutics
- Type
- Journal Article, Research Support, Non-U.S. Gov't, Review
- PMID
- 34129738
Original abstract
Pharmacogenetics (PGx) research over the past 2 decades has produced extensive evidence for the influence of genetic factors on the efficacy and tolerability of antipsychotic treatment. However, the application of these findings to optimize treatment outcomes for patients in clinical practice has been limited. This paper presents a meta-review of key PGx findings related to antipsychotic response and common adverse effects, including antipsychotic-induced weight gain, tardive dyskinesia (TD), and clozapine-induced agranulocytosis (CIAG), and highlights advances and challenges in clinical implementation. Most robust findings from candidate gene and genomewide association studies were reported for associations between polymorphisms in CYP2D6 and exposure and response to specific antipsychotics. As a result, product labels and guidelines from various PGx expert groups have provided selection and dosing recommendations based on CYP2D6 metabolizer phenotypes for commonly prescribed antipsychotics. Other interesting genetic targets include DRD2 for antipsychotic response, SLC18A2 for TD, and the human leukocyte antigen (HLA) genes, HLA-DQB1 and HLA-B, for CIAG. Well-designed studies using large, well-characterized samples that leverages international collaborations are needed to validate previous findings, as well as discover new genetic variants involved in antipsychotic response and adverse effects.