Thoughtful Clinical Use of Pharmacogenetics in Child and Adolescent Psychopharmacology

Laura B. Ramsey, Lisa B. Namerow, Jeffrey R. Bishop, J. Kevin Hicks, Chad Bousman, Paul E. Croarkin, Carol A. Mathews, Sara L. Van Driest, Jeffrey R. Strawn

Research output: Contribution to journalLetterpeer-review

6 Scopus citations

Abstract

AACAP's recent policy statement on Clinical Use of Pharmacogenetic Tests in Prescribing Psychotropic Medications for Children and Adolescents1 recommends that “clinicians avoid using pharmacogenetic testing to select psychotropic medications in children and adolescents.” We agree that there are limitations to the nascent evidence base for using pharmacogenetics, especially in combinatorial form (eg, test results that bin medications based on multiple genes). However, all-or-nothing recommendations fail to recognize the nuance and context of this testing and contrast with the AACAP Facts for Families on pharmacogenetic testing. Moreover, pharmacogenetic testing may inform dosing for antidepressants that are commonly used in child and adolescent psychiatry (eg, sertraline, escitalopram, citalopram, fluvoxamine) as well as the tolerability of some psychotropic medications. With this in mind, we wish to remind the AACAP community of the accumulating evidence and to highlight important principles of pharmacogenetic testing in youths. Specifically: 1) pharmacogenetic testing is not always performed by commercial companies and is not always combinatorial; 2) dosing recommendations or assessment of risk for severe hypersensitivity reactions are based on pharmacogenetics in the Food and Drug Administration (FDA)−approved product inserts for several medications commonly prescribed to children (eg, citalopram, aripiprazole, atomoxetine, carbamazepine, oxcarbazepine at www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling); 3) expert consensus guidelines for dosing or identifying hypersensitivity risk for these drugs are available from the National Institutes of Health (NIH)−supported Clinical Pharmacogenetics Implementation Consortium (CPIC, www.cpicpgx.org/), which provides transparent, regularly updated, and evidence-based evaluations of pharmacogenetic data;2 and 4) randomized trials are not required for clinical dose adjustments; for example, dose adjustments because of decreased hepatic function or concomitant interacting medications are based on pharmacokinetic data, similar to many pharmacokinetic gene-based recommendations from CPIC.

Original languageEnglish (US)
Pages (from-to)660-664
Number of pages5
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume60
Issue number6
DOIs
StatePublished - Jun 1 2021

Bibliographical note

Funding Information:
Disclosure: Dr. Ramsey has received research support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and BTG, International Ltd. Dr. Bishop has received research support from the National Institutes of Health (NIH) and has served as a consultant to OptumRx. Dr. Hicks has served as a paid consultant for Quest Diagnostics, Novartis, and 23andme and has received research support from NIH (P30-CA076292), OneOme, and the American Society of Health-System Pharmacists. Dr. Bousman has received in-kind testing kits from Myriad Neuroscience, CNSDose, Genomind, and AB-Biotics for research purposes and has ongoing research collaborations with MyDNA but has not received payments or received any equity, stocks, or options in these companies or any other pharmacogenetic companies. Dr. Croarkin has received research support from NIH. He has received research support from Pfizer, Inc.; equipment support from Neuronetics, Inc.; and supplies and genotyping services from Assurex Health for investigator-initiated studies. He is the primary investigator for a multicenter study funded by Neuronetics, Inc. and a site primary investigator for a study funded by NeoSync, Inc. He has served as a paid consultant for Procter and Gamble Company and Myriad Neuroscience. Dr. Mathews has received research support from NIH and the Patient Centered Outcomes Research Institute. Dr. Van Driest has received research support from the Doris Duke Foundation, the Burroughs-Wellcome Fund, and NIH (National Institute of General Medical Sciences/National Human Genome Research Institute). Dr. Strawn has received research support from NIH (National Institute of Mental Health/National Institute of Environmental Health Sciences/NICHD), Allergan, Otsuka, and Neuronetics. He has received material support from and provided consultation to Myriad Genetics and has received royalties from the publication of two texts (Springer). He has served as an author for UpToDate, an Associate Editor for Current Psychiatry, and has received honoraria from CMEology and Neuroscience Educational Institute. He has provided consultation to the Food and Drug Administration. Dr. Namerow has reported no biomedical financial interests or potential conflicts of interest. The authors have reported no funding for this work.

PubMed: MeSH publication types

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