Abstract
This review focuses first on the concept of pharmacogenomics and its related concepts (biomarkers and personalized prescription). Next, the first generation of five DNA pharmacogenomic tests used in the clinical practice of psychiatry is briefly reviewed. Then the possible involvement of these pharmacogenomic tests in the exploration of early clinical proof of mechanism is described by using two of the tests and one example from the pharmaceutical industry (iloperidone clinical trials). The initial attempts to use other microarray tests (measuring RNA expression) as peripheral biomarkers for CNS disorders are briefly described. Then the challenge of taking pharmacogenomic tests (compared to drugs) into clinical practice is explained by focusing on regulatory oversight, the methodological/scientific issues concerning diagnostic tests, and cost-effectiveness issues. Current information on medicine-based evidence and cost-effectiveness usually focuses on average patients and not the outliers who are most likely to benefit from personalized prescription. Finally, future research directions are suggested. The future of 'personalized prescription' in psychiatry requires consideration of pharmacogenomic testing and environmental and personal variables that influence pharmacokinetic and pharmacodynamic drug response for each individual drug used by each patient.
| Original language | English |
|---|---|
| Pages (from-to) | 159-172 |
| Number of pages | 14 |
| Journal | Neuropsychopharmacology |
| Volume | 34 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2009 |
Bibliographical note
Funding Information:Dr de Leon is currently a co-investigator in a NIH Small Business Innovation Research Grant 2 R44 MH073291-02 ‘DNA Diagnostics for Minimizing Metabolic Side-Effects of Antipsychotics’ awarded to Genomas Inc. In the past 3 years (since 1 July 2005), Dr de Leon has received researcher-initiated grants from Roche Molecular Systems Inc., and from Eli Lilly (the latter as co-investigator) and was on the advisory board of Roche Molecular Systems Inc. (2006). He personally develops his presentations for lecturing and has never lectured using any pharmaceutical company presentations. In the past three years (since 1 July 2005) his lectures have been supported seven times by Roche Molecular Systems Inc. (once in 2005 and six times in 2006), twice by Eli Lilly (two in 2006), once by Janssen (2006), and once by Bristol-Myers Squibb (2006). He has never been a consultant and has no other financial arrangements with pharmacogenetic or pharmaceutical companies nor owns any of their stocks.
Keywords
- Clozapine-induced agranulocytosis iloperidone
- Cytochrome P450
- Metabolic syndrome-genetics
- Personalized prescription
- Pharmacogenetics
ASJC Scopus subject areas
- Pharmacology
- Psychiatry and Mental health
