CYPRI: a clinical decision-making tool to select psychiatric patients for pharmacogenetic testing

Pharmacogenetic (PGx) testing of cytochrome P450 (CYP) enzymes CYP2D6 and CYP2C19 is increasingly utilised to personalise psychopharmacological treatment, but clear criteria for patient selection are lacking. We developed and conducted a pilot evaluation of a clinical decision-making tool, the CYPRI (CYP Pharmacogenetic Risk Index), which uses routinely available clinical and pharmacological data to estimate the likelihood of a clinically relevant and actionable PGx testing result. A pilot observational study involving 34 patients was conducted at Psychiatric Hospital Bohnice in Prague, Czech Republic. A significant correlation was observed between the CYPRI score and the IMPACT score (ordinal logistic regression: t = 3.279, p = 0.0011; Kendall's τ = 0.46, p = 0.0011). Discriminative ability was high, with an area under the curve (AUC) of 0.83 (95% CI: 0.69-0.97), based on ROC analysis performed using two outcome categories (0-2 vs. ≥ 2 points of IMPACT score). The optimal cut-off was 4. The CYPRI score offers a straightforward method to prioritise patients for PGx testing, potentially enhancing cost-effectiveness and clinical outcomes in psychiatric care.