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Genetic variation in CYP3A43 explains racial difference in olanzapine clearance

Abstract

The antipsychotic drug, olanzapine, one of the most widely used drugs in clinical medicine, has a high rate of discontinuation due to inefficacy and/or adverse effects. We identified a single nucleotide polymorphism in the drug metabolizing enzyme, cytochrome P450 3A43 (CYP3A43; rs472660), that highly significantly predicted olanzapine clearance in the Clinical Antipsychotic Trials of Intervention Effectiveness trial (P=5.9e−7). Moreover, at standard antipsychotic doses, 50% of individuals with the high clearance genotype (AA) have trough blood levels below the therapeutic range. Interestingly, a much higher proportion of African Americans carry the A allele compared with Caucasians (allele frequency 67 vs 14%). After accounting for CYP3A43 genotype, race is no longer a significant predictor of olanzapine clearance. Olanzapine clearance was associated with measures of clinical response. Patients with greater clearance had higher symptom ratings and were more likely to discontinue treatment due to an inadequate response. Our data identify a genetic mechanism for variation in olanzapine response and demonstrate that blood level monitoring of olanzapine treatment is advisable.

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Acknowledgements

This research was supported (in part) by the Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health. The principal investigators of the CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) trial were Jeffrey A Lieberman, MD, T Scott Stroup, MD, MPH and Joseph P McEvoy, MD. The CATIE trial was funded by a grant from the National Institute of Mental Health (N01 MH900001) along with MH074027 (PI PF Sullivan). Genotyping was funded by Eli Lilly and Company. We thank Alette Wessels for sharing the ziprasidone population pharmacokinetic model.

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Correspondence to D R Weinberger.

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Bigos, K., Bies, R., Pollock, B. et al. Genetic variation in CYP3A43 explains racial difference in olanzapine clearance. Mol Psychiatry 16, 620–625 (2011). https://doi.org/10.1038/mp.2011.38

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