1
|
van Westrhenen R, van Schaik RHN, van Gelder T, Birkenhager TK, Bakker PR, Houwink EJF, Bet PM, Hoogendijk WJG, van Weelden-Hulshof MJM. Policy and Practice Review: A First Guideline on the Use of Pharmacogenetics in Clinical Psychiatric Practice. Front Pharmacol 2021; 12:640032. [PMID: 33995044 PMCID: PMC8117336 DOI: 10.3389/fphar.2021.640032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/21/2021] [Indexed: 11/13/2022] Open
Abstract
Effective pharmacologic treatments for psychiatric disorders are available, but their effect is limited due to patients' genetic heterogeneity and low compliance-related to frequent adverse events. Only one third of patients respond to treatment and experience remission. Pharmacogenetics is a relatively young field which focusses on genetic analyses in the context of the metabolism and outcome of drug treatment. These genetic factors can, among other things, lead to differences in the activity of enzymes that metabolize drugs. Recently, a clinical guideline was authorized by the Dutch Clinical Psychiatric Association (NVvP) on the clinical use of pharmacogenetics in psychiatry. The main goal was to provide guidance, based on current evidence, on how to best use genotyping in clinical psychiatric practice. A systematic literature search was performed, and available publications were assessed using the GRADE methodology. General recommendations for psychiatric clinical practice were provided, and specific recommendations per medication were made available. This clinical guideline for caregivers prescribing psychotropic drugs is the product of a broad collaboration of professionals from different disciplines, making use of the information available at the Dutch Pharmacogenetics Working Group (DPWG) and the Clinical Pharmacogenetics Implementation Consortium (CPIC) so far. We summarize the relevant literature and all recommendations in this article. General recommendations are provided and also detailed recommendations per medication. In summary we advise to consider genotyping, when there are side effects or inefficacy for CYP2C19 and CYP2D6. When genotype information is available use this to select the right drug in the right dose for the right patient.
Collapse
Affiliation(s)
- R van Westrhenen
- Outpatient Clinic Pharmacogenetics in Psychiatry, Parnassia Group Amsterdam, Amsterdam, Netherlands.,Maastricht Department of Psychiatry andNeuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - R H N van Schaik
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, Netherlands
| | - T van Gelder
- Dept of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - T K Birkenhager
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | - P R Bakker
- Institute for Mental Health, Arkin, Amsterdam, Netherlands.,Maastricht Department of Psychiatry andNeuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - E J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, Netherlands
| | - P M Bet
- Department of Clinical Chemistry and Hospital Pharmacy, Amsterdam UMC Location VUMC, Amsterdam, Netherlands
| | - W J G Hoogendijk
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | | |
Collapse
|
2
|
Jansen ME, Rigter T, Rodenburg W, Fleur TMC, Houwink EJF, Weda M, Cornel MC. Review of the Reported Measures of Clinical Validity and Clinical Utility as Arguments for the Implementation of Pharmacogenetic Testing: A Case Study of Statin-Induced Muscle Toxicity. Front Pharmacol 2017; 8:555. [PMID: 28878673 PMCID: PMC5572384 DOI: 10.3389/fphar.2017.00555] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/07/2017] [Indexed: 12/19/2022] Open
Abstract
Advances from pharmacogenetics (PGx) have not been implemented into health care to the expected extent. One gap that will be addressed in this study is a lack of reporting on clinical validity and clinical utility of PGx-tests. A systematic review of current reporting in scientific literature was conducted on publications addressing PGx in the context of statins and muscle toxicity. Eighty-nine publications were included and information was selected on reported measures of effect, arguments, and accompanying conclusions. Most authors report associations to quantify the relationship between a genetic variation an outcome, such as adverse drug responses. Conclusions on the implementation of a PGx-test are generally based on these associations, without explicit mention of other measures relevant to evaluate the test's clinical validity and clinical utility. To gain insight in the clinical impact and select useful tests, additional outcomes are needed to estimate the clinical validity and utility, such as cost-effectiveness.
Collapse
Affiliation(s)
- Marleen E Jansen
- Section Community Genetics, Department of Clinical Genetics and Amsterdam Public Health Research Institute, VU University Medical CenterAmsterdam, Netherlands.,Centre for Health Protection, National Institute for Public Health and the EnvironmentBilthoven, Netherlands
| | - T Rigter
- Section Community Genetics, Department of Clinical Genetics and Amsterdam Public Health Research Institute, VU University Medical CenterAmsterdam, Netherlands.,Centre for Health Protection, National Institute for Public Health and the EnvironmentBilthoven, Netherlands
| | - W Rodenburg
- Centre for Health Protection, National Institute for Public Health and the EnvironmentBilthoven, Netherlands
| | - T M C Fleur
- Section Community Genetics, Department of Clinical Genetics and Amsterdam Public Health Research Institute, VU University Medical CenterAmsterdam, Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht UniversityUtrecht, Netherlands
| | - E J F Houwink
- Section Community Genetics, Department of Clinical Genetics and Amsterdam Public Health Research Institute, VU University Medical CenterAmsterdam, Netherlands
| | - M Weda
- Centre for Health Protection, National Institute for Public Health and the EnvironmentBilthoven, Netherlands
| | - Martina C Cornel
- Section Community Genetics, Department of Clinical Genetics and Amsterdam Public Health Research Institute, VU University Medical CenterAmsterdam, Netherlands
| |
Collapse
|
3
|
Kuijper EAM, Houwink EJF, van Weissenbruch MM, Heij HA, Blankenstein MA, Huijser J, Martens F, Lambalk CB. Urinary gonadotropin measurements in neonates: a valuable non-invasive method. Ann Clin Biochem 2016; 43:320-2. [PMID: 16824286 DOI: 10.1258/000456306777695582] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: To measure low neonatal gonadotropin levels, a sensitive non-invasive method is optimal. The aim of the current study was to validate the Architect i2000SR, an automated immunoassay analyser for the measurement of gonadotropins in unextracted neonatal urine samples against serum gonadotropin levels as a gold standard. Methods: Blood and urine were sampled from 30 approximately six-week-old male and female neonates undergoing elective paediatric surgery. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were measured and the urine results were corrected for creatinine. Results: The agreement between neonatal serum and urinary FSH was 0.904 (3-5 h between samples) and 0.704 (18-20 h). For LH, the correlation coefficients were 0.785 and 0.507, respectively. Conclusion: We conclude that gonadotropins can be reliably measured using the Architect on randomly voided, non-extracted urine samples collected from neonates by an adhesive device. Urinary gonadotropin levels are a proper reflection of the serum levels.
Collapse
Affiliation(s)
- E A M Kuijper
- Department of Obstetrics and Gynecology, Division of Reproductive Medicine, VU University medical center, VUmc, and Emma Children's Hospital AMC, 1007 MB Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|