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David A, Fernandez A, Menard ML, Dor E, Leali G, Maria F, Cruzel C, Askenazy F, Verstuyft C, Thümmler S. [Pharmacoresistance to psychotropic drugs in children and adolescents: Pharmacogenetic anomalies of cytochrome P450 2D6]. Encephale 2021; 47:227-234. [PMID: 33551122 DOI: 10.1016/j.encep.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Some patients in child and adolescent psychiatry present resistance to psychotropic drugs, often resulting in polytherapy, an increased risk of adverse events, and more frequent and longer hospitalisation. Psychotropic drugs are mainly metabolised in the liver, in particular by the CYP2D6 subunit of cytochrome P450. Anomalies such as a duplication of the CYP2D6 gene related to an ultra-rapid metaboliser phenotype has been described to be linked to clinical efficacy. However, little research has been done in child and adolescent psychiatry. METHODS A multi-centric cross-sectional study in the southeast of France explored the relation between pharmaco-resistance to psychotropic drugs and the prevalence of duplications or polymorphisms of CYP2D6 associated with an ultra-rapid phenotype in children and adolescents with severe mental health disease. RESULTS Twenty-two patients have been included. The presence of an ultra-rapid phenotype concerns one patient in our study. A second patient presents a slow metaboliser phenotype. CONCLUSIONS This study allows a clinical characterisation of the population of pediatric drug-resistant patients whose severity and the impact of their pathology are major and require long-term care associated with repeated hospitalisations, multiple drug prescriptions and numerous side effects. However, a link between drug resistance to psychotropic drugs and CYP2D6 UFM abnormalities could not be confirmed. An additional pharmacogenetic analysis by a panel of genes applied in the metabolism, transport and action of psychotropic drugs should be considered to answer questions about the resistance and independent effects of CYP2D6.
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Affiliation(s)
- A David
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - A Fernandez
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - M-L Menard
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - E Dor
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - G Leali
- Service de psychiatrie de l'enfant, hôpitaux pédiatriques de Nice, CHU-Lenval, 06200 Nice, France
| | - F Maria
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - C Cruzel
- Délégation à la recherche clinique et à l'innovation, CHU de Nice, 06000 Nice, France
| | - F Askenazy
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France
| | - C Verstuyft
- Service de génétique moléculaire, pharmacogénétique et hormonologie, centre de ressource biologie Paris-Sud, hôpital Bicêtre, groupe hospitalier Paris Sud, AP-HP, Le Kremlin Bicêtre, France; Université Paris-Sud, CESP/UMR-S1178, Équipe "dépression et antidépresseurs", Faculté de médecine, Université Paris-Sud, Inserm, 78, rue Général-Leclerc, 94270 Le Kremlin-Bicêtre, Paris, France
| | - S Thümmler
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France; Université Côte d'Azur, CoBTek, FRIS, Nice, France.
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