Therapeutic Drug Monitoring and Pharmacogenetic Testing as Guides to Psychotropic Drug Dose Adjustment: An Observational Study
To avoid the failures in therapy with psychotropic drugs, treatments can be personalized by applying the results of therapeutic drug monitoring and pharmacogenetic testing. The objective of the present single-center observational study was to describe the changes in psychotropic drug management prom...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-12-01
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| Series: | Pharmaceuticals |
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| Online Access: | https://www.mdpi.com/1424-8247/17/1/21 |
| _version_ | 1827371389683761152 |
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| author | Elodie Cuvelier Houda Khazri Cloé Lecluse Benjamin Hennart Ali Amad Jean Roche Michel Tod Guillaume Vaiva Olivier Cottencin Pascal Odou Delphine Allorge Bertrand Décaudin Nicolas Simon |
| author_facet | Elodie Cuvelier Houda Khazri Cloé Lecluse Benjamin Hennart Ali Amad Jean Roche Michel Tod Guillaume Vaiva Olivier Cottencin Pascal Odou Delphine Allorge Bertrand Décaudin Nicolas Simon |
| author_sort | Elodie Cuvelier |
| collection | DOAJ |
| description | To avoid the failures in therapy with psychotropic drugs, treatments can be personalized by applying the results of therapeutic drug monitoring and pharmacogenetic testing. The objective of the present single-center observational study was to describe the changes in psychotropic drug management prompted by therapeutic drug monitoring and pharmacogenetic testing, and to compare the effective drug concentration based on metabolic status with the dose predicted using an in silico decision tool for drug–drug interactions. The study was conducted in psychiatry wards at Lille University Hospital (Lille, France) between 2016 and 2020. Patients with data for at least one therapeutic drug monitoring session or pharmacogenetic test were included. Blood tests were performed for 490 inpatients (mainly indicated by treatment monitoring or failure) and mainly concerned clozapine (21.4%) and quetiapine (13.7%). Of the 617 initial therapeutic drug monitoring tests, 245 (40%) complied with good sampling practice. Of the patients, 51% had a drug concentration within the therapeutic range. Regardless of the drug concentration, the drug management did not change in 83% of cases. Thirty patients underwent pharmacogenetic testing (twenty-seven had also undergone therapeutic drug monitoring) for treatment failure; the plasma drug concentration was outside the reference range in 93% of cases. The patient’s metabolic status explained the treatment failure in 12 cases (40%), and prompted a switch to a drug metabolized by another CYP450 pathway in 5 cases (42%). Of the six tests that could be analyzed with the in silico decision tool, all of the drug concentrations after adjustment were included in the range estimated by the tool. Knowledge of a patient’s drug concentration and metabolic status (for CYD2D6 and CYP2C19) can help clinicians to optimize psychotropic drug adjustment. Drug management can be optimized with good sampling practice, support from a multidisciplinary team (a physician, a geneticist, and clinical pharmacist), and decision support tools. |
| first_indexed | 2024-03-08T10:38:39Z |
| format | Article |
| id | doaj.art-a60aba57da7444eaaf559629afb425b4 |
| institution | Directory Open Access Journal |
| issn | 1424-8247 |
| language | English |
| last_indexed | 2024-03-08T10:38:39Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmaceuticals |
| spelling | doaj.art-a60aba57da7444eaaf559629afb425b42024-01-26T18:04:52ZengMDPI AGPharmaceuticals1424-82472023-12-011712110.3390/ph17010021Therapeutic Drug Monitoring and Pharmacogenetic Testing as Guides to Psychotropic Drug Dose Adjustment: An Observational StudyElodie Cuvelier0Houda Khazri1Cloé Lecluse2Benjamin Hennart3Ali Amad4Jean Roche5Michel Tod6Guillaume Vaiva7Olivier Cottencin8Pascal Odou9Delphine Allorge10Bertrand Décaudin11Nicolas Simon12CHU Lille, Institut de Pharmacie, F-59000 Lille, FranceCHU Lille, Institut de Pharmacie, F-59000 Lille, FranceCHU Lille, Institut de Pharmacie, F-59000 Lille, FranceCHU Lille, Pôle de Biologie-Pathologie-Génétique, Unité Fonctionnelle de Toxicologie, F-59000 Lille, FranceInserm, CHU Lille, U1172—LilNcog—Lille Neuroscience & Cognition, University Lille, F-59000 Lille, FranceCHU de Lille, Unité de Psychogériatrie, Pôle de Gérontologie, F-59037 Lille, FranceUMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Université Lyon 1, F-69622 Lyon, FranceInserm, CHU Lille, U1172—LilNcog—Lille Neuroscience & Cognition, University Lille, F-59000 Lille, FranceCHU de Lille, Service d’addictologie, CNRS, UMR 9193, SCALab, équipe psyCHIC, CS 70001, Université de Lille, F-59037 Lille, FranceCHU Lille, Institut de Pharmacie, F-59000 Lille, FranceCHU Lille, Pôle de Biologie-Pathologie-Génétique, Unité Fonctionnelle de Toxicologie, F-59000 Lille, FranceCHU Lille, Institut de Pharmacie, F-59000 Lille, FranceCHU Lille, Institut de Pharmacie, F-59000 Lille, FranceTo avoid the failures in therapy with psychotropic drugs, treatments can be personalized by applying the results of therapeutic drug monitoring and pharmacogenetic testing. The objective of the present single-center observational study was to describe the changes in psychotropic drug management prompted by therapeutic drug monitoring and pharmacogenetic testing, and to compare the effective drug concentration based on metabolic status with the dose predicted using an in silico decision tool for drug–drug interactions. The study was conducted in psychiatry wards at Lille University Hospital (Lille, France) between 2016 and 2020. Patients with data for at least one therapeutic drug monitoring session or pharmacogenetic test were included. Blood tests were performed for 490 inpatients (mainly indicated by treatment monitoring or failure) and mainly concerned clozapine (21.4%) and quetiapine (13.7%). Of the 617 initial therapeutic drug monitoring tests, 245 (40%) complied with good sampling practice. Of the patients, 51% had a drug concentration within the therapeutic range. Regardless of the drug concentration, the drug management did not change in 83% of cases. Thirty patients underwent pharmacogenetic testing (twenty-seven had also undergone therapeutic drug monitoring) for treatment failure; the plasma drug concentration was outside the reference range in 93% of cases. The patient’s metabolic status explained the treatment failure in 12 cases (40%), and prompted a switch to a drug metabolized by another CYP450 pathway in 5 cases (42%). Of the six tests that could be analyzed with the in silico decision tool, all of the drug concentrations after adjustment were included in the range estimated by the tool. Knowledge of a patient’s drug concentration and metabolic status (for CYD2D6 and CYP2C19) can help clinicians to optimize psychotropic drug adjustment. Drug management can be optimized with good sampling practice, support from a multidisciplinary team (a physician, a geneticist, and clinical pharmacist), and decision support tools.https://www.mdpi.com/1424-8247/17/1/21pharmacogeneticspsychiatryclinical decision-making tooltherapeutic drug monitoring |
| spellingShingle | Elodie Cuvelier Houda Khazri Cloé Lecluse Benjamin Hennart Ali Amad Jean Roche Michel Tod Guillaume Vaiva Olivier Cottencin Pascal Odou Delphine Allorge Bertrand Décaudin Nicolas Simon Therapeutic Drug Monitoring and Pharmacogenetic Testing as Guides to Psychotropic Drug Dose Adjustment: An Observational Study Pharmaceuticals pharmacogenetics psychiatry clinical decision-making tool therapeutic drug monitoring |
| title | Therapeutic Drug Monitoring and Pharmacogenetic Testing as Guides to Psychotropic Drug Dose Adjustment: An Observational Study |
| title_full | Therapeutic Drug Monitoring and Pharmacogenetic Testing as Guides to Psychotropic Drug Dose Adjustment: An Observational Study |
| title_fullStr | Therapeutic Drug Monitoring and Pharmacogenetic Testing as Guides to Psychotropic Drug Dose Adjustment: An Observational Study |
| title_full_unstemmed | Therapeutic Drug Monitoring and Pharmacogenetic Testing as Guides to Psychotropic Drug Dose Adjustment: An Observational Study |
| title_short | Therapeutic Drug Monitoring and Pharmacogenetic Testing as Guides to Psychotropic Drug Dose Adjustment: An Observational Study |
| title_sort | therapeutic drug monitoring and pharmacogenetic testing as guides to psychotropic drug dose adjustment an observational study |
| topic | pharmacogenetics psychiatry clinical decision-making tool therapeutic drug monitoring |
| url | https://www.mdpi.com/1424-8247/17/1/21 |
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