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Convergence of Pharmacoeconomics and Pharmacogenomics of Antipsychotics: A Review of Pharmacogenetic Diagnostic Tests

https://doi.org/10.52667/2712-9179-2026-6-2-29-45

Abstract

Pharmacogenetic testing (PGx) of polymorphisms that alter the expression of genes asso- ciated with the distribution and response to antipsychotics (APs) can replace the "trial and error" method in AP dosage adjustment and reduce the risk of AP-induced adverse drug reactions (ADRs). This narrative review demonstrates the growing commercial interest in the pharmacogenomics and pharmaco-economics of PGх. However, the significant heterogeneity of pharmacogenetic panels and the lack of unified interpretation standards substantially hinder the implementation of PGх as an advanced tool in personalized psychiatry. The conducted review demonstrates not only techno- logical and commercial progress in the field of PGх for APs but also a complex of interrelated problems that require resolution for the successful translation of this method from the realms of scientific research and commercial services into the routine clinical practice. Although the develop- ment of PGх for identifying at risk patient groups aligns with Russia's new healthcare development strategy, numerous barriers impede its implementation into psychiatric practice. One such barrier is the lack of data on the convergence of pharmacogenomics and pharmacoeconomics of APs. Re- moving this barrier can facilitate the development and real-world clinical implementation of diagnostic pharmacogenetic test systems as a key to a new era of personalized, cost-effective, and safe therapy for mental disorders.

About the Authors

Natalia A. Shnayder
Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology; Shared Core Facilities “Molecular and Cell Technologies”, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University
Russian Federation

3 Bekhterev St., St Petersburg 192019

1 Partizan Zheleznyak St., Krasnoyarsk 660022



Anastasiia A. Abramenko
Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
Russian Federation

3 Bekhterev St., St Petersburg 192019



Evgenia K. Kaisinova
Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
Russian Federation

3 Bekhterev St., St Petersburg 192019



Ekaterina I. Glushchenko
Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
Russian Federation

3 Bekhterev St., St Petersburg 192019



Asiayt M. Shirukova
Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
Russian Federation

3 Bekhterev St., St Petersburg 192019



Irina R. Boyko
Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
Russian Federation

3 Bekhterev St., St Petersburg 192019



Nikolay G. Neznanov
Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
Russian Federation

3 Bekhterev St., St Petersburg 192019



Regina F. Nasyrova
Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology
Russian Federation

3 Bekhterev St., St Petersburg 192019



References

1. Filippova I. Pharmacoeconomics: from drug price to outcome price. Remedium. Journal on the Russian Market of Drugs and Medical Equipment. 2010; 9: 7-15. (In Russ.)

2. Reshet'ko O.V., Lutsevich K.A. Pharmacoeconomics as an instrument of clinical pharmacology for optimization of phar-macotherapy (review). The Bulletin of the Scientific Centre for Expert Evaluation of Medicinal Products. 2015; 4: 54-57. (In Russ.)

3. Ivashchenko D.V., Nasyrova R.F., Ivanov M.V., Neznanov N.G. The history of pharmacogenetics in psychiatry. Pharmaco-genetics and Pharmacogenomics. 2015; 2: 33-40. (In Russ.)

4. Dokukina T.V., Gilep A.A., Golubeva T.S., et al. Improving pharmacogenetic testing for personalized therapy - a doctrine of global healthcare development. Meditsinskie Novosti. 2017; 5: 45-49. (In Russ.)

5. Ivashchenko D.V., Sosin D.N., Kirnichnaya K.A., et al. Economic feasibility of pharmacogenetic testing for antipsychotic prescribing. Pharmacogenetics and Pharmacogenomics. 2015; 1: 30-39. (In Russ.)

6. Kurylev A.A., Andreev B.V., Kolbin A.S., Limankin O.V. CYP2D6 genotyping in psychiatric inpatient practice – pharmaco-economic aspects. Pharmacoeconomics. Modern Pharmacoeconomics and Pharmacoepidemiology. 2018; 11 (1): 19-26. (In Russ.)

7. Vilyum I.A., Andreev B.V., Proskurin M.A., Balykina Yu.E. Pharmacoeconomic analysis of using typical and atypical anti-psychotics in schizophrenia. Farmacoeconomika. Modern Pharmacoeconomics and Pharmacoepidemiology. 2018;11(2):9-24. (In Russ.) https://doi.org/10.17749/2070-4909.2018.11.2.009-024

8. Otmakhov A.P., Proydina D.S., Kibirova A.Y., et al. The role of pharmacogenetic testing in optimizing antipsychotic therapy. Personalized Psychiatry and Neurology. 2024;4(4):34-42. (In Russ.) https://doi.org/10.52667/2712-9179-2024-4-4-34-42

9. Richards-Brown M., Wei Y., Abidoph R., et al. Patient and clinician perspectives on pharmacogenetic testing for antipsy-chotics. Frontiers in Pharmacology. 2025; 16. https://doi.org/10.3389/fphar.2025.1689300

10. Shad M.U. Genetic testing for antipsychotic pharmacotherapy: from laboratory research to clinical application. Behav. Sci. 2021; 11: 97. https://doi.org/10.3390/bs11070097

11. Shnayder N.A., Bochanova E.N., Dmitrenko D.V., Nasyrova R.F. Pharmacogenetics of carbamazepine. Epilepsia i paroksiz-mal'nye sostoianiya. 2019;11(4):364-378. (In Russ.). https://doi.org/17749/2077-8333.2019.11.4.364-378

12. Kaptsis D., Lewis M., Sorich M., Battersby M. Long-read sequencing of CYP2D6 may improve psychotropic prescribing and treatment outcomes: a systematic review and meta-analysis. J Psychopharmacol. 2024; 38(9):771-783. https://doi.org/10.1177/02698811241268899

13. de Brabander E., Kleine Schaars K., van Amelsvoort T.; PSY-PGx Consortium; van Westrhenen R. Influence of CYP2C19 and CYP2D6 on side effects of aripiprazole and risperidone: a systematic review. J Psychiatr Res. 2024; 174:137-152. https://doi.org/10.1016/j.jpsychires.2024.04.001

14. Vaskova L.B., Tyapkina M.V., Mikhailovko E.V. Comparative analysis of antipsychotic drug consumption in inpatient treatment of schizophrenia: a retrospective study with 5-year follow-up. Farmacoeconomika. Sovremennaia farmakoekonomika i farmakoepidemiologiia. 2020;13(3):251-261. (In Russ.). https://doi.org/17749/2070-4909/farmakoekonomika.2020.053

15. Jameson A., Faisal M., Fylan B., et al. Proportion of antipsychotics with CYP2D6 pharmacogenetic (PGx) associations pre-scribed in an Early Intervention in Psychosis (EIP) cohort: a cross-sectional study. J Psychopharmacol. 2024; 38(4):382-394. https://doi.org/10.1177/02698811241238283

16. Decree No. 896 "On the Strategy for the Development of Healthcare in the Russian Federation for the Period up to 2030." Available at: http://kremlin.ru/acts/news/78680 (In Russ.)

17. Shnayder N.A., Vaiman E.E., Nasyrova R.F. Antipsychotic-induced parkinsonism: a risk assessment scale and personalised diagnosis algorithm. Safety and Risk of Pharmacotherapy. 2025;13(1):70-85. https://doi.org/10.30895/2312-7821-2024-418 (In Russ.)

18. Abdullaev M.A., Kantemirova B.I., Bashkina O.A., et al. Artificial intelligence in pharmacogenetics: a narrative review of current and future applications. Acta Biomedica Scientifica. 2024;9(5):12-21. https://doi.org/10.29413/ABS.2024-9.5.2 (In Russ.)

19. Erahtina O.S. Approaches to regulating relations in the sphere of developing and using the artificial intelligence technologies: features and practical applicability. Journal of Digital Technologies and Law. 2023;1(2):421–437. https://doi.org/10.21202/jdtl.2023.17.

20. Sychev D.A., Belousov D.Yu., Mirzaev K.B. Ten years at the forefront of personalized medicine: from achievements to future transformation. Pharmacogenetics and Pharmacogenomics. 2025;(1):3-8. https://doi.org/10.37489/2588-0527-2025-1-3-8. (In Russ.)

21. Gorodetsky M.A., Aleksandrova E.N. Personnel policy as a driver of pharmaceutical development. Vestnik Nauki. 2025; 2 (5): 49-55. https://doi.org/10.24412/2712-8849-2025-586-49-55 (In Russ.)

22. Aboelbaha S., Zolezzi M., Abdallah O., Eltorki Y. Mental health prescribers' perceptions on the use of pharmacogenetic testing in the management of depression in the Middle East and North Africa region. Pharmgenomics Pers Med. 2023; 16: 503-518. https://doi.org/10.2147/PGPM.S410240.

23. Vest B.M., Wray L.O., Brady L.A., et al. Primary care and mental health providers' perceptions of implementation of phar-macogenetics testing for depression prescribing. BMC Psychiatry. 2020; 20(1):518. doi: 10.1186/s12888-020-02919-z

24. Liko I., Lai E., Griffin R. J., et al. Patients' perspectives on psychiatric pharmacogenetic testing. Pharmacopsychiatry. 2020; 53(6): 256–261. https://doi.org/10.1055/a-1183-5029

25. Laplace B., Calvet, B., Lacroix A., et al. Acceptability of pharmacogenetic testing among French psychiatrists, a national survey. Journal of Personalized Medicine. 2021; 11(6): 446. https://doi.org/10.3390/jpm11060446

26. Bousman C.A., Oomen A., Jessel C.D., et al. Perspectives on the clinical use of pharmacogenetic testing in late-life mental healthcare: a survey of the American Association of Geriatric Psychiatry Membership. The American journal of geriatric psy-chiatry: official journal of the American Association for Geriatric Psychiatry. 2022; 30(5): 560–571. https://doi.org/10.1016/j.jagp.2021.09.013

27. McCarthy M. J., Chen Y., Demodena A., et al. Attitudes on pharmacogenetic testing in psychiatric patients with treat-ment-resistant depression. Depression and anxiety. 2020; 37(9): 842–850. https://doi.org/10.1002/da.23074

28. Hahn M., Frantz A. M., Eckert A., Reif A. Barriers for implementation of PGx testing in psychiatric hospitals in Germany: results of the FACT-PGx study. Fortschritte der Neurologie-Psychiatrie. 2024; 92(6): 221–229. https://doi.org/10.1055/a-2060-0694

29. Jameson A., Tomlinson J., Medlinskiene K., et al. Normalising the implementation of pharmacogenomic (PGx) testing in adult mental health settings: a theory-based systematic review. Journal of personalized medicine. 2024: 14(10): 1032. https://doi.org/10.3390/jpm14101032

30. Ward E.T., Kostick K.M., Lázaro-Muñoz G. Integrating genomics into psychiatric practice: ethical and legal challenges for clinicians. Harvard review of psychiatry. 2019: 27(1): 53-64. https://doi.org/10.1097/HRP.0000000000000203

31. Federal Law "On the Fundamentals of Public Health Protection in the Russian Federation" No. 323-FZ dated 21.11.2011 (latest edition). Available at: https://www.consultant.ru/document/cons_doc_LAW_121895 (In Russ.)

32. Order of the Ministry of Health of Russia No. 1094n dated 24.11.2021 "On Approval of the Procedure for Prescribing Me-dicinal Products, Forms of Prescription Forms for Medicinal Products, the Procedure for Completing the Said Forms, Their Recording and Storage, Forms of Prescription Forms Containing Prescriptions of Narcotic Drugs or Psychotropic Substances, the Procedure for Their Manufacture, Distribution, Registration, Recording and Storage, as well as the Rules for Completing Prescription Forms, Including in the Form of Electronic Documents" (Registered with the Ministry of Justice of Russia 30.11.2021 No. 66124). Available at: https://www.consultant.ru/document/cons_doc_LAW_401865/ (In Russ.)

33. Order of the Ministry of Health of the Russian Federation No. 575n dated November 2, 2012 "On Approval of the Procedure for Providing Medical Care in the Field of 'Clinical Pharmacology'." Available at: https://base.garant.ru/70288220 (In Russ.)

34. Order of the Ministry of Health of the Russian Federation No. 66n dated August 3, 2012 "On Approval of the Procedure and Timeframes for Medical and Pharmaceutical Workers to Improve Professional Knowledge and Skills Through Training in Additional Professional Educational Programs in Educational and Scientific Organizations." Available at: https://base.garant.ru/70222886 (In Russ.)

35. Letter of the Ministry of Health of Russia No. 17-4/10/2-6989 dated 06.10.2017 "On Clinical Guidelines (Treatment Protocols) for the Provision of Medical Care." Available at: https://www.consultant.ru/document/cons_doc_LAW_319682 (In Russ.)

36. Zakharova N.V., Nasyrova R.F. Towards personalized psychiatry: foreign experience in psychopharmacogenetics. Lex Ge-netica. 2025;4(2):76-93. doi: 10.17803/lexgen-2025-4-2-76-93 (In Russ.)

37. CPIC – Clinical Pharmacogenetics Implementation Consortium. Available at: https://cpicpgx.org

38. FDA – U.S. Food and Drug Administration. Available at: https://www.fda.gov/

39. Hertz D.L., Bousman C.A., McLeod H.L., et al. Recommendations for pharmacogenetic testing in clinical practice guidelines in the US. Am J Health Syst Pharm. 2024; 81(16):672-683. https://doi.org/10.1093/ajhp/zxae110.

40. Correction to: comparison of FDA table of pharmacogenetic associations and clinical pharmacogenetics implementation consortium guidelines. Am J Health Syst Pharm. 2022; 79(18):1512. https://doi.org/10.1093/ajhp/zxac183.

41. DPWG – The Dutch Pharmacogenetics Working Group. Available at: https://www.knmp.nl/dossiers/farmacogenetica

42. EMA – European Medicines Agency. Available at: https://www.ema.europa.eu/en/homepage

43. CPNDS – The Canadian Pharmacogenomics Network for Drug Safety. Available at: https://cpnds.ubc.ca

44. PMDA – Pharmaceuticals and Medical Devices Agency (Japan). Available at: https://www.pmda.go.jp/english/

45. RNPGx – Réseau national de pharmacogénétique. Available at: https://www.rnpgx.fr/

46. PharmVar – Pharmacogene Variation Consortium. Available at: https://www.pharmvar.org

47. PharmGKB – The Pharmacogenomics Knowledge Base. Available at: https://www.pharmgkb.org

48. Choong E., Polari A., Kamdem R. H., et al. Pharmacogenetic study on risperidone long-acting injection: influence of cyto-chrome P450 2D6 and pregnane X receptor on risperidone exposure and drug-induced side-effects. Journal of clinical psy-chopharmacology. 2013; 33(3): 289-298. https://doi.org/10.1097/JCP.0b013e31828f62cd

49. Wang Z.H., Zhan Y.Y., Li Y.X., et al. Effects of 24 CYP2D6 variants found in the chinese population on the metabolism of risperidone. Pharmacology. 2015; 96(5-6): 290–295. https://doi.org/10.1159/000441007

50. Sukasem Ch., Hongkaew Y., Ngamsamut N., et al. Impact of pharmacogenetic markers of CYP2D6 and DRD2 on prolactin response in risperidone-treated thai children and adolescents with autism spectrum disorders. Journal of Clinical Psycho-pharmacology. 2016; 36(2):141-146. https://doi.org/10.1097/JCP.0000000000000474

51. Rossow K. M., Oshikoya K. A., Aka I. T., et al. Evidence for pharmacogenomic effects on risperidone outcomes in pediatrics. Journal of Developmental and Behavioral Pediatrics. 2021; 42(3):205-212. https://doi.org/10.1097/DBP.0000000000000883

52. Xing Q., Qian X., Li H., et al. The relationship between the therapeutic response to risperidone and the dopamine D2 receptor polymorphism in Chinese schizophrenia patients. International Journal of Neuropsychopharmacology. 2007; 10 (5): 631–637. https://doi.org/10.1017/S146114570600719X

53. Hong C.J., Liou Y.J., Bai Y. M., et al. Dopamine receptor D2 gene is associated with weight gain in schizophrenic patients under long-term atypical antipsychotic treatment. Pharmacogenetics and Genomics.2010; 20(6):359-366. https://doi.org/10.1097/FPC.0b013e3283397d06

54. Zhang J.P., Robinson D. G., Gallego J. A., et al. Association of a schizophrenia risk variant at the DRD2 locus with antipsy-chotic treatment response in first-episode psychosis. Schizophrenia Bulletin. 2015; 41 (6):1248–1255. https://doi.org/10.1093/schbul/sbv116

55. Shilbayeh S.A.R., Adeen I.S., Alhazmi A.S., et al. The polymorphisms of candidate pharmacokinetic and pharmacodynamic genes and their pharmacogenetic impacts on the effectiveness of risperidone maintenance therapy among Saudi children with autism. Eur J Clin Pharmacol. 2024; 80:869–890. https://doi.org/10.1007/s00228-024-03658-w

56. Shi Y., Li M., Song C., Xu Q., et al. Combined study of genetic and epigenetic biomarker risperidone treatment efficacy in Chinese Han schizophrenia patients. Transl Psychiatry. 2017;7:e1170. https://doi.org/10.1038/tp.2017.143

57. Beunk L., Nijenhuis M., Soree B., de Boer-Veger N. J., et al. Dutch Pharmacogenetics Working Group (DPWG) guideline for the gene-drug interaction between CYP2D6, CYP3A4 and CYP1A2 and antipsychotics. European journal of human genetics: EJHG. 2024; 32(3):278–285. https://doi.org/10.1038/s41431-023-01347-3

58. Whirl-Carrillo M., Huddart R., Gong L., et al. An evidence-based framework for evaluating pharmacogenomics knowledge for personalized medicine. Clinical pharmacology and therapeutics. 2021; 110(3): 563–572. doi: 10.1002/cpt.2350

59. Gong L., Whirl-Carrillo M., Klein T. E. PharmGKB, an integrated resource of pharmacogenomic knowledge. Current protocols. 2021; 1(8): e226. https://doi.org/10.1002/cpz1.226

60. Abdullah-Koolmees H., van Keulen A. M., Nijenhuis M., Deneer V. H. M. Pharmacogenetics guidelines: overview and comparison of the DPWG, CPIC, CPNDS, and RNPGx guidelines. Frontiers in Pharmacology. 2021; 11: 595219. https://doi.org/10.3389/fphar.2020.595219

61. List of VIP Pharmacogenes ClinPGx. Available at: https://www.clinpgx.org/vips

62. Order of the Ministry of Labor of Russia No. 477n dated 31.07.2020 (as amended on 30.08.2023) "On Approval of the Pro-fessional Standard 'Physician – Clinical Pharmacologist'" (Registered with the Ministry of Justice of Russia 26.08.2020 No. 59475) (In Russ.)

63. Teng Y., Sandhu A., Liemburg E. J., et al. The progress and pitfalls of pharmacogenetics-based precision medicine in schizophrenia spectrum disorders: a systematic review and meta-analysis. Journal of personalized medicine. 2023; 13(3): 471. https://doi.org/10.3390/jpm13030471

64. Islam F., Men X., Yoshida K., et al. Pharmacogenetics-guided advances in antipsychotic treatment. Clinical pharmacology and therapeutic. 2021; 110(3): 582–588. https://doi.org/10.1002/cpt.2339

65. Das S., Kalita M., Makhal M., Devaraja M., Bagepally B. S., Cherian J. J., Aadityan R., Bhattacharjee M., Mondal S., Sen S., Mondal M., Basu A., Dutta A. K., Saha I., et al. Pharmacogenomics-assisted treatment versus standard of care in schizo-phrenia: a systematic review and meta-analysis. BMC psychiatry. 2024; 24(1): 663. https://doi.org/10.1186/s12888-024-06104-4

66. Gurevich E. K. Assessment of the effectiveness of pharmacological genotyping in psychiatry. Sotsial'naya i Klinicheskaya Psikhiatriya. 2022; 32 (2): 91-94 (In Russ.)

67. Morris S. A., Alsaidi A. T., Verbyla A., et al. Cost effectiveness of pharmacogenetic testing for drugs with clinical Phar-macogenetics Implementation Consortium (CPIC) guidelines: a systematic review. Clinical pharmacology and therapeutics. 2022; 112(6): 1318–1328. https://doi.org/10.1002/cpt.2754

68. Verma S. S., Keat K., Li B., et al. Evaluating the frequency and the impact of pharmacogenetic alleles in an ancestrally diverse Biobank population. Journal of translational medicine. 2022; 20(1): 550. https://doi.org/10.1186/s12967-022-03745-5

69. Demarina S.M., Sirotkina A.M., Usolkin A.A., Dombrovskaya E.D. Pharmacogenetic testing: ethical challenges and solutions. Meditsinskaia Etika. 2025; (4): 47–50. https://doi.org/10.24075/medet.2025.027 (In Russ.)

70. Shnayder N.A., Glushchenko E.I., Abramenko A.A., et al. Frequencies of variable alleles of the ABCB1 gene and their role in response to antipsychotic therapy in patients with schizophrenia spectrum disorders: Narrative Review. Personalized Psy-chiatry and Neurology. 2026; 1(6):15-30. https://doi.org/10.52667/2712-9179-2026-6-1-15-30

71. Bezerra H. S., Brasileiro Costa A. L., Pinto R. S., et al. Economic impact of pharmaceutical services on polymedicated patients: a systematic review. Research in Social & Administrative Pharmacy: RSAP. 2022; 18(9): 3492–3500. https://doi.org/10.1016/j.sapharm.2022.03.005


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Shnayder N.A., Abramenko A.A., Kaisinova E.K., Glushchenko E.I., Shirukova A.M., Boyko I.R., Neznanov N.G., Nasyrova R.F. Convergence of Pharmacoeconomics and Pharmacogenomics of Antipsychotics: A Review of Pharmacogenetic Diagnostic Tests. Personalized Psychiatry and Neurology. 2026;6(2):29-45. https://doi.org/10.52667/2712-9179-2026-6-2-29-45

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