In an interview, Dr. Andrew J. Cutler, Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University and Chief Medical Officer of Science Education Institute, shared his insights on treatment selection for schizophrenia patients. He highlighted the challenges in matching the mechanism of action of drugs to individual patient pathology due to the absence of reliable biomarkers. Dr. Cutler emphasized that some patients respond better to certain medications, but predicting their response remains challenging. Clinical trials provide limited guidance, as they report average effects in patient groups rather than considering individual variations. Therefore, clinicians often choose medications based on symptom presentation and potential side effects. The heterogeneity of schizophrenia, both clinically and neurobiologically, further complicates treatment selection. Dr. Cutler discussed the potential of KarXT, a novel drug combining xanomeline and trospium, which represents a paradigm shift in schizophrenia treatment by not blocking D2 receptors. He emphasized the need for biomarkers to match patients to the most appropriate treatment. Dr. Cutler also addressed challenges in developing novel agents targeting dopaminergic neurotransmission, such as identifying appropriate patient populations and understanding long-term effects. He expressed optimism about the potential of new mechanisms of action and the combination of drugs to improve treatment outcomes while acknowledging the need for ongoing research to ensure safety and cost-effectiveness.
Optimizing Treatment Selection for Schizophrenia: A Perspective from the 2024 AAPP Conference
