Clinical predictors may guide lithium dosing in bipolar disorder – Consumer Health News

THURSDAY, May 19, 2022 (HealthDay News) — A model including six clinical variables could be used to guide lithium dosing, according to a study published in the June issue of The Lancet Psychiatry.

Vincent Millischer, MD, of the Karolinska Institutet in Stockholm, and colleagues conducted a population pharmacokinetic study involving two Swedish clinical cohorts with 2,357 patients who were dosed with lithium and had clinically relevant plasma lithium concentrations. The natural logarithm of the total body clearance of lithium (CLLi) associated with clinical variables was examined.

Researchers found that clinical predictors of CLLi included age, gender, estimated glomerular filtration rate (eGFR), co-medication with diuretics, and agents acting on the renin-aldosterone-angiotensin system. There was an observed association between CLLi and serum lithium, with a lower CLLi associated with an increase in serum lithium. In a genome-wide association study, one locus (rs583503) was associated with a change in CLLi. Enrichment of associations with genes expressed in kidney marrow and cortex was also observed, as well as associations with polygenic risk score for eGFR, body mass index, and blood urea nitrogen. . A model including six clinical predictors explained 61.4 and 49.8% of the variance of CLLi in cohorts 1 and 2, respectively. No major improvement in the models was observed with the addition of genetic markers.

“Replacing the current time-consuming empirical titration with dose prediction models based on individual clinical data could reduce the time to reach therapeutic lithium concentrations, increase patient compliance, and therefore improve clinical care for patients with bipolar disorder,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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