Genetics can be used to predict a patient's response to antipsychotic treatment for schizophrenia, according to a recent study by researchers at the Feinstein Institute of Medical Research. The results were published online today in American Journal of Psychiatry.
Schizophrenia is a leading cause of disability in the U.S. It is characterized by delusions, hallucinations, and disorganized thoughts and behaviors. Currently, the condition is treated with antipsychotic drugs, but this therapy is administered without the guidance of laboratory tests to demonstrate efficacy, as is common in other areas of medicine. Doctors often use "trial and error" when choosing a treatment for schizophrenia, not knowing if patients will respond well. This uncertainty places a heavy burden not only on patients and their families but also on health professionals and health systems.
For this study, Feinstein Institute professor Todd Lencz, PhD, and his team used genetic testing to predict the final response to medications in patients suffering the first episode of schizophrenia. Instead of testing a single gene, the researchers used a relatively new approach called "polygenic risk scores."
"Polygenic risk scores represent the combined effects of many thousands of genetic variants across the genome and best represent the very complex genetic nature of schizophrenia," said Jian-Ping Zhang, MD, PhD, assistant professor at the Feinstein Institute and lead author . of the study.
The researchers found that patients with higher polygenic risk scores, or higher genetic disease burden, were less likely to respond to conventional antipsychotic treatment. These results were replicated in two independent cohorts, representing an international collaboration of scientists from the Feinstein Institute with researchers from across Europe, further emphasizing that this approach should be further explored.
"The results we find open the doors to precision medicine approaches to psychiatry, and more specifically, the use of polygenic scores as a new technology for the treatment of psychiatric disorders," Dr Lencz.
The researchers hope to expand the study, with the ultimate goal of developing clinical guidelines for the use of polygenic risk scores and other predictors (such as brain scans) in the treatment of schizophrenia.
"The work of Drs. Lencz and Zhang is a breakthrough in the field of precision medicine for schizophrenia," said Kevin J. Tracey, MD, president and chief executive officer of the Feinstein Institute. "Tailored therapy for a patient's polygenic risk scores potentially represents a major advance over current trial and error approaches.