1
|
Veldic M, Ahmed AT, Blacker CJ, Geske JR, Biernacka JM, Borreggine KL, Moore KM, Prieto ML, Vande Voort JL, Croarkin PE, Hoberg AA, Kung S, Alarcon RD, Keeth N, Singh B, Bobo WV, Frye MA. Cytochrome P450 2C19 Poor Metabolizer Phenotype in Treatment Resistant Depression: Treatment and Diagnostic Implications. Front Pharmacol 2019; 10:83. [PMID: 30837869 PMCID: PMC6389687 DOI: 10.3389/fphar.2019.00083] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Pharmacogenomic testing, specifically for pharmacokinetic (PK) and pharmacodynamic (PD) genetic variation, may contribute to a better understanding of baseline genetic differences in patients seeking treatment for depression, which may further impact clinical antidepressant treatment recommendations. This study evaluated PK and PD genetic variation and the clinical use of such testing in treatment seeking patients with bipolar disorder (BP) and major depressive disorder (MDD) and history of multiple drug failures/treatment resistance. Methods: Consecutive depressed patients evaluated at the Mayo Clinic Depression Center over a 10-year study time frame (2003–2013) were included in this retrospective analysis. Diagnoses of BP or MDD were confirmed using a semi-structured diagnostic interview. Clinical rating scales included the Hamilton Rating Scale for Depression (HRSD24), Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Adverse Childhood Experiences (ACE) Questionnaire. Clinically selected patients underwent genotyping of cytochrome P450 CYP2D6/CYP2C19 and the serotonin transporter SLC6A4. PK and PD differences and whether clinicians incorporated test results in providing recommendations were compared between the two patient groups. Results: Of the 1795 patients, 167/523 (31.9%) with BP and 446/1272 (35.1%) with MDD were genotyped. Genotyped patients had significantly higher self-report measures of depression and anxiety compared to non-genotyped patients. There were significantly more CYP2C19 poor metabolizer (PM) phenotypes in BP (9.3%) vs. MDD patients (1.7%, p = 0.003); among participants with an S-allele, the rate of CYP2C19 PM phenotype was even higher in the BP (9.8%) vs. MDD (0.6%, p = 0.003). There was a significant difference in the distribution of SLC6A4 genotypes between BP (l/l = 28.1%, s/l = 59.3%, s/s = 12.6%) and MDD (l/l = 31.4%, s/l = 46.1%, s/s = 22.7%) patients (p < 0.01). Conclusion: There may be underlying pharmacogenomic differences in treatment seeking depressed patients that potentially have impact on serum levels of CYP2C19 metabolized antidepressants (i.e., citalopram / escitalopram) contributing to rates of efficacy vs. side effect burden with additional potential risk of antidepressant response vs. induced mania. The evidence for utilizing pharmacogenomics-guided therapy in MDD and BP is still developing with a much needed focus on drug safety, side effect burden, and treatment adherence.
Collapse
Affiliation(s)
- Marin Veldic
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Ahmed T Ahmed
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Caren J Blacker
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Jennifer R Geske
- Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Joanna M Biernacka
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States.,Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Kristin L Borreggine
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Katherine M Moore
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Miguel L Prieto
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de los Andes, Santiago, Chile.,Servicio de Salud Mental, Clínica Universidad de los Andes, Santiago, Chile
| | - Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Astrid A Hoberg
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Renato D Alarcon
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States.,Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nicola Keeth
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| |
Collapse
|
2
|
Altar CA, Carhart J, Allen JD, Hall-Flavin D, Winner J, Dechairo B. Clinical Utility of Combinatorial Pharmacogenomics-Guided Antidepressant Therapy: Evidence from Three Clinical Studies. MOLECULAR NEUROPSYCHIATRY 2015; 1:145-55. [PMID: 27606312 DOI: 10.1159/000430915] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/23/2015] [Indexed: 11/19/2022]
Abstract
DNA of 258 patients with treatment-resistant depression was collected in three 8-10 week, two-arm, prospective clinical trials. Forty-four allelic variations were measured in genes for the cytochrome P450 (CYP) enzymes CYP2D6, CYPC19, and CYP1A2, the serotonin transporter (SLC6A4), and the 5-HT2A receptor (HTR2A). The combinatorial pharmacogenomic (CPGx™) GeneSight test results were provided to clinicians to support medication changes from baseline (guided arm), or they were provided at the end of each study to clinicians of unguided patients who were treated as usual (TAU). TAU subjects who at baseline were prescribed medications genetically discordant for them showed only a 12% symptom improvement, far less than the 32.5% or 28.5% improvements of the TAU subjects on yellow-category ('use with caution'; p = 0.002) or green-category medications ('use as recommended'; p = 0.02), respectively. The odds of a clinical response were increased 2.3-fold among all GeneSight-guided compared to all TAU subjects (p = 0.004), and overall, the guided group had a 53% greater improvement in depressive symptoms (p = 0.0002), a 1.7-fold relative improvement in response (p = 0.01), and a number needed to treat for one clinical response above that seen in the TAU group of 6.07.
Collapse
Affiliation(s)
| | | | | | - Daniel Hall-Flavin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn., USA
| | - Joel Winner
- AssureRx Health, Inc., Mason, Ohio, USA; Winner Psychiatry, Boulder, Colo., USA
| | | |
Collapse
|