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In the United Kingdom, there is a mandatory requirement for absolute neutrophil count (ANC) and white blood cell count (WBC) monitoring to safeguard against agranulocytosis. Some people have naturally low ANCs without increased infection risk, caused by a homozygous T\u2009&gt;\u2009C variant in\n                    <jats:italic>ACKR1<\/jats:italic>\n                    , commonly called the Duffy\u2010null genotype. This condition is known as ADAN (\n                    <jats:italic>ACKR1<\/jats:italic>\n                    \/\n                    <jats:italic>DARC<\/jats:italic>\n                    \u2010associated neutropenia) and synonyms include DANC (Duffy\u2010null associated neutrophil count) and BEN (benign ethnic neutropenia). It is usual UK practice to lower WBC\/ANC thresholds for people confirmed to have ADAN. However, ADAN often remains undetected, resulting in unnecessary discontinuation and exclusion from clozapine. This CERSI\u2010PGx guideline provides a framework to offer\n                    <jats:italic>ACKR1<\/jats:italic>\n                    genotype testing within the existing clinical pathway. We recommend three eligibility criteria, including pre\u2010emptive testing for all people starting clozapine, testing for people registered in the Central Non\u2010Rechallenge Database and reactive testing following a below\u2010threshold blood result (defined as \u2018amber\u2019 or \u2018red\u2019). We recommend that people with the Duffy\u2010null genotype should be monitored using revised WBC\/ANC thresholds for ADAN. Regardless of\n                    <jats:italic>ACKR1<\/jats:italic>\n                    genotype, haematology input is required for people returning a WBC\u2009&lt;\u20092.0\u2009\u00d7\u200910\n                    <jats:sup>9<\/jats:sup>\n                    \/L and\/or ANC\u2009&lt;\u20091.0\u2009\u00d7\u200910\n                    <jats:sup>9<\/jats:sup>\n                    \/L who present with a key clinical feature, such as sustained temperature \u226538\u00b0C. Finally, we summarize health economic evidence, estimating in the first year of testing, 129 people with the Duffy\u2010null genotype could be identified, resulting in savings ranging from \u00a342\u2009732 to \u00a3727\u2009990. We propose\n                    <jats:italic>ACKR1<\/jats:italic>\n                    testing as a cost\u2010effective approach for facilitating access to clozapine, the optimal therapy for treatment\u2010resistant schizophrenia.\n                  <\/jats:p>","DOI":"10.1002\/bcp.70576","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T08:40:45Z","timestamp":1778661645000},"page":"1977-1990","source":"Crossref","is-referenced-by-count":5,"title":["<i>ACKR1<\/i>\n                    \/Duffy\u2010null genotype testing for clozapine: A guideline developed by the UK Centre of Excellence in Regulatory Science and Innovation in Pharmacogenomics (CERSI\u2010PGx)"],"prefix":"10.1002","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7440-7095","authenticated-orcid":false,"given":"Stephen","family":"Murtough","sequence":"first","affiliation":[{"name":"Division of Psychiatry University College London  London 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