Establishing the characteristics of an effective pharmacogenetic test for clozapine-induced agranulocytosis

TY - JOUR

T1 - Establishing the characteristics of an effective pharmacogenetic test for clozapine-induced agranulocytosis

AU - Verbelen, M.

AU - Collier, D. A.

AU - Cohen, D.

AU - MacCabe, J. H.

AU - Lewis, C. M.

N1 - © 2015 Macmillan Publishers Limited All rights reserved 1470-269X/15

PY - 2015/10/24

Y1 - 2015/10/24

N2 - Clozapine is the only evidence-based therapy for treatment-resistant schizophrenia, but it induces agranulocytosis, a rare but potentially fatal haematological adverse reaction, in less than 1% of users. To improve safety, the drug is subject to mandatory haematological monitoring throughout the course of treatment, which is burdensome for the patient and one of the main reasons clozapine is underused. Therefore, a pharmacogenetic test is clinically useful if it identifies a group of patients for whom the agranulocytosis risk is low enough to alleviate monitoring requirements. Assuming a genotypic marker stratifies patients into a high-risk and a low-risk group, we explore the relationship between test sensitivity, group size and agranulocytosis risk. High sensitivity minimizes the agranulocytosis risk in the low-risk group and is essential for clinical utility, in particular in combination with a small high-risk group.

AB - Clozapine is the only evidence-based therapy for treatment-resistant schizophrenia, but it induces agranulocytosis, a rare but potentially fatal haematological adverse reaction, in less than 1% of users. To improve safety, the drug is subject to mandatory haematological monitoring throughout the course of treatment, which is burdensome for the patient and one of the main reasons clozapine is underused. Therefore, a pharmacogenetic test is clinically useful if it identifies a group of patients for whom the agranulocytosis risk is low enough to alleviate monitoring requirements. Assuming a genotypic marker stratifies patients into a high-risk and a low-risk group, we explore the relationship between test sensitivity, group size and agranulocytosis risk. High sensitivity minimizes the agranulocytosis risk in the low-risk group and is essential for clinical utility, in particular in combination with a small high-risk group.

UR - http://www.scopus.com/inward/record.url?scp=84924111048&partnerID=8YFLogxK

U2 - 10.1038/tpj.2015.5

DO - 10.1038/tpj.2015.5

M3 - Article

SN - 1470-269X

VL - 15

SP - 461

EP - 466

JO - The pharmacogenomics journal

JF - The pharmacogenomics journal

IS - 5

ER -