Zusammenfassung
In der vorliegenden Arbeit aus dem Referat Neurobiologie und Genetik der Deutschen Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) wird der Stand der Literatur zur Bedeutung pharmakogenetischer Befunde zur Pharmakokinetik und Pharmakodynamik von Antidepressiva, Antipsychotika und Lithium zusammengefasst. Besonders hingewiesen wird auf die Arbeit internationaler Expertengruppen und Regulierungsbehörden. In Deutschland liegt eine erste Stellungnahme der Gendiagnostikkommission des Gesundheitsministeriums am Robert-Koch-Institut vor. Die DGPPN hat im Anhörungsverfahren die Empfehlung zur CYP2D6-Bestimmung vor dem Einsatz trizyklischer Antidepressiva unterstützt und empfiehlt darüber hinaus bei asiatischen Patienten vor einem Einsatz von Carbamazepin die Bestimmung des HLA-B*1502-Genotyps. Haupthindernis für den flächendeckenden Einsatz pharmakogenetischer Bestimmungen für eine sicherere und effektivere Pharmakotherapie psychischer Erkrankungen ist das Fehlen prospektiver Studien zu einzelnen und vor allem zu der Kombination genetischer Varianten. Hier sind Psychiater, Humangenetiker und Drittmittelgeber im Interesse der Patienten gefordert.
Abstract
In this article, the current literature on pharmacogenetics of antidepressants, antipsychotics and lithium are summarized by the section of Neurobiology and Genetics of the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN). The publications of international expert groups and regulatory authorities are reviewed and discussed. In Germany, a statement on pharmacogenetics was also made by the gene diagnostics committee of the Ministry of Health. The DGPPN supports two recommendations: 1) to perform CYP2D6 genetic testing prior to prescription of tricyclic antidepressants and 2) to determine the HLA-B*1502 genotype in patients of Asian origin before using carbamazepine. The main obstacle for a broad application of pharmacogenetic tests in psychiatry remains the lack of large prospective studies, for both single gene-drug pair and cobinatorial pharmacogenetic tests, to evaluate the benefits of genetic testing. Psychiatrists, geneticists and funding agencies are encouraged to increase their efforts for the future benefit of psychiatric patients.
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D.J. Müller, E.J. Brandl, F. Degenhardt, K. Domschke, H. Grabe, O. Gruber, J. Hebebrand, W. Maier, A. Menke, M. Riemenschneider, M. Rietschel, D. Rujescu, T.G. Schulze, L. Tebartz van Elst, O. Tüscher und J. Deckert geben an, dass kein Interessenkonflikt besteht.
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D. J. Müller und E. J. Brandl teilen sich die Erstautorenschaft.
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Müller, D.J., Brandl, E.J., Degenhardt, F. et al. Pharmakogenetik in der Psychiatrie: eine Standortbestimmung. Nervenarzt 89, 290–299 (2018). https://doi.org/10.1007/s00115-017-0479-8
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DOI: https://doi.org/10.1007/s00115-017-0479-8