PT  - JOURNAL ARTICLE
AU  - Chiara Fabbri
AU  - Katherine E. Tansey
AU  - Roy H. Perlis
AU  - Joanna Hauser
AU  - Neven Henigsberg
AU  - Wolfgang Maier
AU  - Ole Mors
AU  - Anna Placentino
AU  - Marcella Rietschel
AU  - Daniel Souery
AU  - Gerome Breen
AU  - Charles Curtis
AU  - Sang-Hyuk Lee
AU  - Stephen Newhouse
AU  - Hamel Patel
AU  - Michael O’Donovan
AU  - Glyn Lewis
AU  - Gregory Jenkins
AU  - Richard M. Weinshilboum
AU  - Anne Farmer
AU  - Katherine J. Aitchison
AU  - Ian Craig
AU  - Peter McGuffin
AU  - Koen Schruers
AU  - Joanna M. Biernacka
AU  - Rudolf Uher
AU  - Cathryn M. Lewis
TI  - Effect of cytochrome CYP2C19 metabolizing activity on antidepressant response and side effects: meta-analysis of data from genome-wide association studies
AID  - 10.1101/259838
DP  - 2018 Jan 01
TA  - bioRxiv
PG  - 259838
4099  - http://biorxiv.org/content/early/2018/02/06/259838.short
4100  - http://biorxiv.org/content/early/2018/02/06/259838.full
AB  - Cytochrome (CYP) P450 enzymes have a primary role in antidepressant metabolism and variants in these polymorphic genes are targets for pharmacogenetic investigation. This is the first meta-analysis to investigate how CYP2C19 polymorphisms predict citalopram/escitalopram efficacy and side effects.CYP2C19 phenotypes comprise poor metabolizers (PM), intermediate and intermediate+ metabolizers (IM; IM+), extensive and extensive+ metabolizers (EM [wild type]; EM+) and ultra-rapid metabolizers (UM) defined by the two most common CYP2C19 functional polymorphisms (rs4244285 and rs12248560) in Caucasians. These polymorphisms were genotyped or imputed from genome-wide data in four samples treated with citalopram or escitalopram (GENDEP, STAR*D, GenPod, PGRN-AMPS). Treatment efficacy was percentage symptom improvement and remission. Side effect data were available at weeks 2–4, 6 and 9 in three of the investigated samples. A fixed-effects meta-analysis was performed using EM as the reference group.Analysis of 2558 patients for efficacy and 2037 patients for side effects showed that PMs had higher symptom improvement (SMD=0.43, CI=0.19–0.66) and higher remission rates (OR=1.55, CI=1.23–1.96) compared to EMs. At weeks 2–4, PMs showed higher risk of gastro-intestinal (OR=1.26, CI=1.08–1.47), neurological (OR=1.28, CI=1.07–1.53) and sexual side effects (OR=1.52, CI=1.23–1.87; week 6 values similar). No difference was seen at week 9 or in total side effect burden. PMs did not have higher risk of dropout at week 4 compared to EMs. Antidepressant dose was not different among CYP2C19 groups.CYP2C19 polymorphisms may provide helpful information for guiding citalopram/escitalopram treatment, despite PMs are relatively rare among Caucasians (~2%).