1
|
Ramaraj R, Al-Mahayri ZN, Saleous R, Abdel Aziz K, Al-Mugaddam F, Al-Sabousi M, Alhassani A, Ahbabi NAA, Stip E, Patrinos GP, Ali BR, Arnone D. The Utility of CYP2D6 and CYP2C19 Variants to Guide Pharmacological Treatment in Complex Unipolar Major Depression: A Pilot Longitudinal Study. Psychiatr Q 2023; 94:435-447. [PMID: 37490261 PMCID: PMC10460303 DOI: 10.1007/s11126-023-10044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
Major depression is a frequent condition which variably responds to treatment. In view of its high prevalence, the presence of treatment resistance in major depression significantly impacts on quality of life. Tailoring pharmacological treatment based on genetic polymorphisms is a current trend to personalizing pharmacological treatment in patients with major depressive disorders. Current guidelines for the use of genetic tests in major depression issued by the Clinical Pharmacogenomics Implementation Consortium (CPIC) are based on CYP2D6 and CYP2C19 polymorphisms which constitute the strongest evidence for pharmacogenomic guided treatment. There is evidence of increased clinical response to pharmacological treatment in major depression although largely in non-treatment resistant patients from Western countries. In this study, well characterised participants (N = 15) with complex, largely treatment resistant unipolar major depression were investigated, and clinical improvement was measured at baseline and at week-8 after the pharmacogenomics-guided treatment with the Montgomery Åsberg Depression Rating Scale (MÅDRS). Results suggested a statistically significant improvement (p = 0.01) of 16% at endpoint in the whole group and a larger effect in case of changes in medication regime (28%, p = 0.004). This small but appreciable effect can be understood in the context of the level of treatment resistance in the group. To our knowledge, this is the first study from the Middle East demonstrating the feasibility of this approach in the treatment of complex major depressive disorders.
Collapse
Affiliation(s)
- Reshma Ramaraj
- Department of Psychiatry and Behavioural Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Zeina N Al-Mahayri
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Reema Saleous
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Karim Abdel Aziz
- Department of Psychiatry and Behavioural Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fadwa Al-Mugaddam
- Department of Psychiatry and Behavioural Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mouza Al-Sabousi
- Behavioural Science Institute, Al-Ain Hospital, United Arab Emirates Al Ain, Al-Ain, United Arab Emirates
| | - Aysha Alhassani
- Behavioural Science Institute, Al-Ain Hospital, United Arab Emirates Al Ain, Al-Ain, United Arab Emirates
| | - Noura Ali Al Ahbabi
- Behavioural Science Institute, Al-Ain Hospital, United Arab Emirates Al Ain, Al-Ain, United Arab Emirates
| | - Emmanuel Stip
- Department of Psychiatry and Behavioural Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Université de Montréal, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - George P Patrinos
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
- Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Bassam R Ali
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Danilo Arnone
- Department of Psychiatry and Behavioural Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
- Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
| |
Collapse
|
2
|
Youssef E, Kirkdale CL, Wright DJ, Guchelaar HJ, Thornley T. Estimating the potential impact of implementing pre-emptive pharmacogenetic testing in primary care across the UK. Br J Clin Pharmacol 2021; 87:2907-2925. [PMID: 33464647 DOI: 10.1111/bcp.14704] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 02/01/2023] Open
Abstract
AIMS Pharmacogenetics (PGx) in the UK is currently implemented in secondary care for a small group of high-risk medicines. However, most prescribing takes place in primary care, with a large group of medicines influenced by commonly occurring genetic variations. The goal of this study is to quantitatively estimate the volumes of medicines impacted by implementation of a population-level, pre-emptive pharmacogenetic screening programme for nine genes related to medicines frequently dispensed in primary care in 2019. METHODS A large community pharmacy database was analysed to estimate the national incidence of first prescriptions for 56 PGx drugs used in the UK for the period 1 January-31 December 2019. These estimated prescription volumes were combined with phenotype frequency data to estimate the occurrence of actionable drug-gene interactions (DGI) in daily practice in community pharmacies. RESULTS In between 19.1 and 21.1% (n = 5 233 353-5 780 595) of all new prescriptions for 56 drugs (n = 27 411 288 new prescriptions/year), an actionable drug-gene interaction (DGI) was present according to the guidelines of the Dutch Pharmacogenetics Working Group and/or the Clinical Pharmacogenetics Implementation Consortium. In these cases, the DGI would result in either increased monitoring, guarding against a maximum ceiling dose or an optional or immediate drug/dose change. An immediate dose adjustment or change in drug regimen accounted for 8.6-9.1% (n = 2 354 058-2 500 283) of these prescriptions. CONCLUSIONS Actionable drug-gene interactions frequently occur in UK primary care, with a large opportunity to optimise prescribing.
Collapse
Affiliation(s)
- Essra Youssef
- School of Pharmacy, University of East Anglia, Norwich, UK
| | | | - David J Wright
- School of Pharmacy, University of East Anglia, Norwich, UK
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tracey Thornley
- Boots UK, Thane Road, Nottingham, UK.,School of Pharmacy, University of Nottingham, Nottingham, UK
| |
Collapse
|