TY - JOUR
T1 - Optimisation of pharmacotherapy in psychiatry through therapeutic drug monitoring, molecular brain imaging and pharmacogenetic tests
T2 - Focus on antipsychotics
AU - Hart, Xenia Marlene
AU - Gründer, Gerhard
AU - Ansermot, Nicolas
AU - Conca, Andreas
AU - Corruble, Emmanuelle
AU - Crettol, Severine
AU - Cumming, Paul
AU - Frajerman, Ariel
AU - Hefner, Gudrun
AU - Howes, Oliver
AU - Jukic, Marin M
AU - Kim, Euitae
AU - Kim, Seoyoung
AU - Maniscalco, Ignazio
AU - Moriguchi, Sho
AU - Müller, Daniel J.
AU - Nakajima, Shinichiro
AU - Osugo, Martin
AU - Paulzen, Michael
AU - Ruhe, Henricus Gerardus
AU - Scherf-Clavel, Maike
AU - Schoretsanitis, Georgios
AU - Serretti, Alessandro
AU - Spina, Edoardo
AU - Spigset, Olav
AU - Steimer, Werner
AU - Süzen, Sinan H.
AU - Uchida, Hiroyuki
AU - Unterecker, Stefan
AU - Vandenberghe, Frederik
AU - Verstuyft, Celine
AU - Zernig, Gerald
AU - Hiemke, Christoph
AU - Eap, Chin B.
N1 - Publisher Copyright:
© 2024 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2024
Y1 - 2024
N2 - 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, specialised tools are used. Three tools have been proven useful to personalise drug treatments: therapeutic drug monitoring (TDM) of drug levels, pharmacogenetic testing (PG), and molecular neuroimaging. Methods: In these Guidelines, we provide an in-depth review of pharmacokinetics, pharmacodynamics, and pharmacogenetics for 45 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: 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: 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 optimise treatment effects, minimise side effects and ultimately reduce the global burden of diseases, personalised drug treatment has not yet become the standard of care in psychiatry.
AB - 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, specialised tools are used. Three tools have been proven useful to personalise drug treatments: therapeutic drug monitoring (TDM) of drug levels, pharmacogenetic testing (PG), and molecular neuroimaging. Methods: In these Guidelines, we provide an in-depth review of pharmacokinetics, pharmacodynamics, and pharmacogenetics for 45 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: 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: 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 optimise treatment effects, minimise side effects and ultimately reduce the global burden of diseases, personalised drug treatment has not yet become the standard of care in psychiatry.
KW - therapeutic drug monitoring, pharmacogenetic testing, molecular neuroimaging, antipsychotics
UR - http://www.scopus.com/inward/record.url?scp=85202975004&partnerID=8YFLogxK
U2 - 10.1080/15622975.2024.2366235
DO - 10.1080/15622975.2024.2366235
M3 - Review article
C2 - 38913780
AN - SCOPUS:85202975004
SN - 1562-2975
VL - 25
SP - 451
EP - 536
JO - World Journal of Biological Psychiatry
JF - World Journal of Biological Psychiatry
IS - 9
ER -