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Pharmacogenetic approach to increase efficacy and safety of schizophrenia treatment with antipsychotics

A.O. Kibitov1, D.V. Ivashchenko2,3, D.A. Sychev2
1 Federal medical research centre of psychiatry and narcology named after V. P. Serbsky of the Ministry of health
2 Russian medical Academy of continuous education" of Ministry of health of the Russian Federation
3 Moscow scientific and practical center of narcology of the Department of health of Moscow

Introduction. There is interindividual variability of antipsychotics’ efficacy and safety in terms of schizophrenia treatment. Such variability may be caused as by exogenic factors, as by inherited features: genetic differences in biological systems, which influence on antipsychotics pharmacokinetics and pharmacodynamics. The result of pharmacogenetics test is the possibility to predict individual antipsychotics’ efficacy and safety before prescription.

Aim of current review – to analyse contemporary data for evaluation possibilities to utilize pharmacogenetic approach in schizophrenia treatment with antiopsychotics.

Results. To date, genetic markers of severe adverse events' risk caused by antipsychotics, but there is lack of evidence base to predict therapeutic effect of antipsychotics. Pharmacogenetic testing of CYP2D6 which metabolizes the most of antipsychotics was included into overseas guidelines for prescription of haloperidol, aripiprazole, risperidone, perphenazine, zucklopentixole, clozapine, tioridazine. Before wide national research in this field, all guidelines should be interpreted with caution. Many antipsychotics and particularly long-action forms have not approved pharmacogenetics recommendations. In case of high genetic risk of antipsychotics’ severe adverse events, a patient need to conduct therapeutic drug monitoring and clinical pharmacologist’s consultation.

Conclusion. Instruments to translate pharmacogenetics testing's results (pharmacogenetics and pharmacodynamics genes) as complex decision-making supporting algorithms for antipsychotics' personalized therapy of schizophrenia will be helpful in real clinical pactice.

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