Exploring Biologic Predictors of Response Disparities to Atypical Antipsychotics among Blacks: A Quasi-Systematic Review

Purpose: Management of schizophrenia among Blacks in the United States is af­fected by persistent disparities. This review explored response to atypical antipsychotics among Blacks compared with other groups to assess systematic variation that may con­tribute to disparities. Methods: We conducted a quasi-systematic review of studies reporting response to atypical antipsychotics among Blacks com­pared with other groups, including effects of genetic variation. Results: Of 48 identified research articles, 29 assessed differences in outcomes without inclusion of genetic variation and 20 ex­plored effects of genetic variation; of note: one article included both types of data. Analysis of the 29 papers with clinical out­comes only suggests that while data on ef­ficacy and risk of movement disorders were heterogeneous, findings indicate increased risk of metabolic effects and neutropenia among Blacks. Of the 20 articles exploring effects of genetic variation, allelic or geno­typic variations involving several genes were associated with altered efficacy or safety among Blacks but not Whites, including risk of decreased response involving variation in DRD4 and DRD1 , and improved efficacy as­sociated with variants in DRD2 , COMT , and RGS4 . Others showed significant improve­ment in treatment response only among Whites, including variation in DTNBP1 , DRD4 , and GNB3 . Conclusions: The current analysis can help tailor management among Blacks using an atypical antipsychotic. Heterogeneity in genetic variation effects and response allele frequency suggests that pharmacogenetics approaches for atypical antipsychotics will need to explicitly incorporate race and eth­nicity. Ethn Dis. 2020;30(Suppl 1):229-240; doi:10.18865/ed.30.S1.229