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T86

A SYSTEMATIC LITERATURE REVIEW ON ANTI-PSYCHOTIC UTILIZATION IN MINORITY POPULATIONS AND KEY CLINICAL CONSIDERATIONS

Jasmyn Brown — Misbah Alam2, Momilani Tupu1, Emily Tran1, Jessica Nguyen1, Jameson Chua1, Mustafa Alam3, Zain Hazari4, Abdul Khan2, Saba Saleem2, Mujeeb Shad5, Faisal Suba2 1Touro University Nevada, 2The Valley Health System, 3American Medical Research, 4Ponce Health Sciences University, 5University of Nevada, Las Vegas

2026 ASCP Annual Meeting

Introduction

Recent research has highlighted disparities in minority subgroups in the diagnoses of psychotic disorders. Some studies have attributed these disparities to social determinants of health (SDOH). Further research shows disparities in the antipsychotics utilized to treat these psychotic disorders. However, less research has been done to determine if race and ethnicity may shape the pharmacological response and treatment outcomes.

Aim

Our main objective is to explore antipsychotic use amongst ethnic minorities and determine whether certain clinical considerations should be had when prescribing this class of medication within these populations.

Methods

A literature search was conducted on PubMed with a focus on peer-reviewed articles published within the last 5 years exploring antipsychotic utilization in minority populations. The search string included ‘Antipsychotic’ (and) ‘Black’/’Hispanic’/’EastAsian’/’South Asians’/’Native Hawaiians’/’Pacific Islander’/’Native American’ patients. 282 articles screened. After excluding case reports, literature reviews, meta-analyses, and editorials, the search yielded 38 articles included in our review.

Results

Anti-psychotic use and response differed amongst different minority populations. Clozapine was well-studied, and several studies highlighted the underutilization of clozapine as a treatment option for Hispanic, Black, and Native American patients with psychotic disorders. Results show that Black and Native American patients have an increased prevalence of benign ethnic neutropenia (BEN) (4.6% and 10.1%, respectively), which may lead to an overestimation of the risk of severe neutropenia and hesitation for use. In contrast, East-Asian patients showed an increase in adverse reactions to standard clozapine titration, were slower metabolizers, and found benefit at lower doses, resulting in a decrease in tolerability to clozapine if standard treatment guidelines were followed in this population. Risperidone was also well-studied amongst minority populations. Black patients had better adherence and lower positive symptoms on a long-acting injectable (LAI) risperidone than oral risperidone, but no significant improvement was noted in their Hispanic counterparts. Additionally, CYP2D6*17 alleles commonly found in individuals of Sub-Saharan African ancestry can increase the metabolism of risperidone and decrease its efficacy. When looking at Chinese patients, specific NRG1 gene polymorphisms determined cognitive improvement with risperidone use, whereas positive psychotic symptoms improved regardless of the genotype. In Korean patients, risperidone had an 80% increased relative risk of drug-induced Parkinsonism, when compared to aripiprazole, but no clinically significant increase in risk for dystonia or akathisia. East Asian patients were also found to be slower metabolizers for SGAs such as lurasidone, brexpiprazole, and quetiapine, possibly needing lower doses, but had favorable tolerability to aripiprazole. Black patients were less likely to have trialed with a second-generation anti-psychotic (SGA) before LAI initiation when compared to other groups. Amongst LAIs, Paliperidone LAI was frequently found to be well-tolerated across all minorities.

Conclusion

Minority populations show distinct clinical considerations in antipsychotic dosing, tolerability, and adverse effects. Factoring in the racial and ethnic differences will allow us to maximize on treatment options that are already available and improve treatment outcomes and adherence. Further research comparing antipsychotic metabolism and response in minority populations is still needed.