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Roth M, King L, St Cyr K, Mohsin U, Balderson K, Rhind S, Goldman A, Richardson D. Evaluating the prospective utility of pharmacogenetics reporting among Canadian Armed Forces personnel receiving pharmacotherapy: a preliminary assessment towards precision psychiatric care. BMJ Mil Health 2024; 170:440-445. [PMID: 37657847 DOI: 10.1136/military-2023-002447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/18/2023] [Indexed: 09/03/2023]
Abstract
Pharmacological interventions for treating posttraumatic stress disorder in Canadian Armed Forces (CAF) members and Veterans often achieve modest results. The field of pharmacogenetics, or the study of how genes influence an individual's response to different medications, offers insight into how prior knowledge of gene-drug interactions may potentially improve the trial-and-error process of drug selection in pharmacotherapy, thereby improving treatment effects and remission rates. Given the relative recency of pharmacogenetics testing and sparse research in military samples, we used pharmacogenetics testing in a small pilot group (n=23) of CAF members and Veterans who were already engaged in pharmacotherapy for a service-related mental health condition to better understand the associated opportunities and challenges of pharmacogenetics testing in this population. Our preliminary evaluation involved: (1) reporting the prevalence of pharmacogenetics testing 'bin' status according to participants' reports ('green', 'yellow' or 'red'; intending to signal 'go', 'caution' or 'stop', regarding the potential for gene-drug interactions); (2) calculating the percentage of currently prescribed psychotropic medications that were assessed and included in the reports; (3) evaluating whether prescribers used pharmacogenetics testing information according to clinical notes and (4) collecting informal feedback from participating psychiatrists. While pharmacogenetics testing appeared to provide valuable information for a number of clients, a major limitation was the number of commonly prescribed medications not included in the reports.
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Affiliation(s)
- Maya Roth
- Operational Stress Injury Clinic-Greater Toronto Site, St. Joseph's Health Care, London, Toronto, Ontario, Canada
- MacDonald Franklin Operational Stress Injury Research Centre, London, Ontario, Canada
| | - L King
- Operational Stress Injury Clinic - Parkwood Main Site, SJHC, London, Ontario, Canada
| | - K St Cyr
- MacDonald Franklin Operational Stress Injury Research Centre, London, Ontario, Canada
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - U Mohsin
- University of Toronto, Toronto, Ontario, Canada
| | - K Balderson
- Operational Stress Injury Clinic - Parkwood Main Site, SJHC, London, Ontario, Canada
| | - S Rhind
- Defence Research and Development Canada, Toronto, Ontario, Canada
| | - A Goldman
- DNA Labs Canada Inc, Toronto, Ontario, Canada
| | - D Richardson
- MacDonald Franklin Operational Stress Injury Research Centre, London, Ontario, Canada
- Operational Stress Injury Clinic - Parkwood Main Site, SJHC, London, Ontario, Canada
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Wu A, Raack EJ, Ross CJD, Carleton BC. Implementation and Evaluation Strategies for Pharmacogenetic Testing in Hospital Settings: A Scoping Review. Ther Drug Monit 2024:00007691-990000000-00266. [PMID: 39264345 DOI: 10.1097/ftd.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/01/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Pharmacogenetic testing in clinical settings has improved the safety and efficacy of drug treatment. There is a growing number of studies evaluating pharmacogenetic implementation and identifying barriers and facilitators. However, no review has focused on bridging the gap between identifying barriers and facilitators of testing and the clinical strategies adopted in response. This review was conducted to understand the implementation and evaluation strategies of pharmacogenetic testing programs. METHODS A PRISMA-compliant scoping review was conducted. The included studies discussed pharmacogenetic testing programs implemented in a hospital setting. Quantitative, qualitative, and mixed design methods were included. RESULTS A total of 232 of the 7043 articles that described clinical pharmacogenetic programs were included. The most common specialties that described pharmacogenetic implementation were psychiatry (26%) and oncology (16%), although many studies described institutional programs implemented across multiple specialties (19%). Different specialties reported different clinical outcomes, but all reported similar program performance indicators, such as test uptake and the number of times the test recommendations were followed. There were benefits and drawbacks to delivering test results through research personnel, pharmacists, and electronic alerts, but active engagement of physicians was necessary for the incorporation of pharmacogenetic results into clinical decision making. CONCLUSIONS Further research is required on the maintenance and sustainability of pharmacogenetic testing initiatives. These findings provide an overview of the implementation and evaluation strategies of different specialties that can be used to improve pharmacogenetic testing.
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Affiliation(s)
- Angela Wu
- Department of Experimental Medicine, University of British Columbia
- BC Children's Hospital Research Institute
| | - Edward J Raack
- BC Children's Hospital Research Institute
- Department of Medical Genetics, University of British Columbia
| | - Colin J D Ross
- BC Children's Hospital Research Institute
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia; and
| | - Bruce C Carleton
- BC Children's Hospital Research Institute
- Department of Medical Genetics, University of British Columbia
- Division of Translational Therapeutics, Department of Pediatrics, University of British Columbia; and
- Therapeutic Evaluation Unit, Provincial Health Services Authority, Vancouver, British Columbia, Canada
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Santenna C, Shubham A, Ratinder J, Abhijit R, Tamonud M, Jitendra S, Shamim MA, Balakrishnan S. Drug metabolizing enzymes pharmacogenetic variation-informed antidepressant therapy approach for common mental disorders: A systematic review and meta-analysis. J Affect Disord 2024; 367:832-844. [PMID: 39265864 DOI: 10.1016/j.jad.2024.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 08/22/2024] [Accepted: 09/08/2024] [Indexed: 09/14/2024]
Abstract
IMPORTANCE Currently, 30-50 % of individuals with depression and 40 % with anxiety-collectively referred to as common mental disorders (CMDs), exhibit inadequate responses to antidepressant treatments. OBJECTIVE To assess the effectiveness and safety of drug-metabolizing enzyme pharmacogenetic variation informed treatment (PGxIT) versus usual antidepressant treatment (UT) in patients with CMDs. DATA SOURCES A literature search was conducted in the MEDLINE, Scopus, and Cochrane Library databases from inception until January 30, 2024. STUDY SELECTION Studies were selected based on CMD diagnoses, reporting on the genetic variations of drug-metabolizing enzyme (DME) genes in relation to antidepressants, involving PGxIT and UT groups with human subjects, and published in English. DATA EXTRACTION AND SYNTHESIS Data extraction and quality assessment were performed independently by two authors. A pooled risk ratio (RR) with 95 % CI was estimated using both random and fixed-effect models, and heterogeneity was assessed using Cochran's Q test and the I2 statistic. The publication bias of eligible studies was assessed using post hoc Doi plots and the LFK index. RESULTS This systematic review included 18 studies (n = 7021). The PGxIT demonstrated greater efficacy in the remission of symptoms of depressive disorder at 8 weeks (RR 1.523 [95 % CI: 1.255-1.843]; I2 = 48 %) and 12 weeks (RR 1.631 [95 % CI: 1.001-2.657]; I2 = 86 %; p < 0.01), and symptoms of anxiety disorder compared to UT. Additionally, the risk of adverse drug events (ADEs) was significantly lower in the PGxIT group (RR = 0.65 [95 % CI: 0.52-0.82]; I2 = 0 %) than in the UT group. The certainty of evidence for both outcomes was moderate. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis suggest that pharmacogenetically guided antidepressant treatment, based on genetic variation in drug-metabolizing enzymes, is associated with superior efficacy in the remission of symptoms for patients with depressive disorders and a reduction in ADEs compared to usual treatment and the findings of the systematic review for remission in anxiety disorders indicate that, PGx guided treatment is also associated with increased remission of symptoms in anxiety disorders compared to usual treatment.
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Affiliation(s)
- Chenchula Santenna
- Department of Pharmacology, All India Institute of Medical Sciences-Bhopal, Madhya Pradesh 462020, India.
| | - Atal Shubham
- Department of Pharmacology, All India Institute of Medical Sciences-Bhopal, Madhya Pradesh 462020, India
| | - Jhaj Ratinder
- Department of Pharmacology, All India Institute of Medical Sciences-Bhopal, Madhya Pradesh 462020, India
| | - Rozatkar Abhijit
- Department of Psychiatry, All India Institute of Medical Sciences-Bhopal, Bhopal 462020, India
| | - Modak Tamonud
- Department of Psychiatry, All India Institute of Medical Sciences-Bhopal, Bhopal 462020, India
| | - Singh Jitendra
- Department of Translational Medicine(,) All India Institute of Medical Sciences-Bhopal, Bhopal 462020, India
| | - Muhammad Aaqib Shamim
- Department of Pharmacology, All India Institute of Medical Sciences - Jodhpur, Jodhpur 342005, India
| | - S Balakrishnan
- Department of Pharmacology, All India Institute of Medical Sciences-Bhopal, Madhya Pradesh 462020, India
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Tesfamicael KG, Zhao L, Fernández-Rodríguez R, Adelson DL, Musker M, Polasek TM, Lewis MD. Efficacy and safety of pharmacogenomic-guided antidepressant prescribing in patients with depression: an umbrella review and updated meta-analysis. Front Psychiatry 2024; 15:1276410. [PMID: 39086729 PMCID: PMC11289719 DOI: 10.3389/fpsyt.2024.1276410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 06/26/2024] [Indexed: 08/02/2024] Open
Abstract
Aim To determine the efficacy and safety of pharmacogenomics (PGx)-guided antidepressant prescribing in patients with depression through an umbrella review and updated meta-analysis. Methods A comprehensive systematic search was conducted on PsycINFO, PubMed, Embase and the Cochrane databases. The pooled effect sizes of randomized controlled trials (RCTs) were expressed as mean differences for continuous data and risk ratios for noncontinuous data. Results Patients who received PGx-guided medications were 41% to 78% more likely to achieve remission and 20% to 49% more likely to respond to antidepressants than patients receiving treatment-as-usual (TAU). Conclusion PGx-guided antidepressant prescribing improves the treatment of depression. However, the significance and magnitude of the benefit varies widely between studies and different PGx testing panels. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022321324.
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Affiliation(s)
- Kiflu G. Tesfamicael
- School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
- Lifelong Health, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Lijun Zhao
- Lifelong Health, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | | | - David L. Adelson
- School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Michael Musker
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas M. Polasek
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Martin David Lewis
- School of Biological Sciences, University of Adelaide, Adelaide, SA, Australia
- Lifelong Health, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
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Baum ML, Widge AS, Carpenter LL, McDonald WM, Cohen BM, Nemeroff CB. Pharmacogenomic Clinical Support Tools for the Treatment of Depression. Am J Psychiatry 2024; 181:591-607. [PMID: 38685859 DOI: 10.1176/appi.ajp.20230657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE In this review, the authors update the 2018 position statement of the American Psychiatric Association Council of Research Workgroup on Biomarkers and Novel Treatments on pharmacogenomic (PGx) tools for treatment selection in depression. METHODS The literature was reviewed for new clinical trials and meta-analyses, published from 2017 to 2022, of studies using PGx tools for treatment selection in depression. The blinding and control conditions, as well as primary and secondary outcomes and post hoc analyses, were summarized. RESULTS Eleven new clinical trials and five meta-analyses were identified; all studies had primary outcome measures related to speed or efficacy of treatment response. Three trials (27%) demonstrated efficacy on the primary outcome measure with statistical significance; the three studies used different PGx tools; one study was open-label and the other two were small single-blind trials. Five trials (45%) did not detect efficacy with statistical significance on either primary or secondary outcome measures. Only one trial (9%) used adverse events as a primary outcome measure. All studies had significant limitations; for example, none adopted a fully blinded study design, only two studies attempted to blind the treating clinician, and none incorporated measures to estimate the effectiveness of the blinds or the influence of lack of blinding on the study results. CONCLUSIONS The addition of these new data do not alter the recommendations of the 2018 report, or the advice of the U.S. Food and Drug Administration, that the evidence does not support the use of currently available combinatorial PGx tools for treatment selection in major depressive disorder. Priority efforts for future studies and the development and testing of effective tools include fully blinded study designs, inclusion of promising genetic variants not currently included in any commercially available tests, and investigation of other uses of pharmacogenomics, such as estimating the likelihood of rare adverse drug effects, rather than increasing the speed or magnitude of drug response.
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Affiliation(s)
- Matthew L Baum
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baum); Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge); Butler Hospital Neuromodulation Research Facility, Providence, R.I., and Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Carpenter); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald); Department of Psychiatry and Program for Neuropsychiatric Research, McLean Hospital, Harvard Medical School, Belmont, Mass. (Cohen); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin (Nemeroff)
| | - Alik S Widge
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baum); Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge); Butler Hospital Neuromodulation Research Facility, Providence, R.I., and Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Carpenter); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald); Department of Psychiatry and Program for Neuropsychiatric Research, McLean Hospital, Harvard Medical School, Belmont, Mass. (Cohen); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin (Nemeroff)
| | - Linda L Carpenter
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baum); Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge); Butler Hospital Neuromodulation Research Facility, Providence, R.I., and Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Carpenter); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald); Department of Psychiatry and Program for Neuropsychiatric Research, McLean Hospital, Harvard Medical School, Belmont, Mass. (Cohen); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin (Nemeroff)
| | - William M McDonald
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baum); Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge); Butler Hospital Neuromodulation Research Facility, Providence, R.I., and Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Carpenter); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald); Department of Psychiatry and Program for Neuropsychiatric Research, McLean Hospital, Harvard Medical School, Belmont, Mass. (Cohen); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin (Nemeroff)
| | - Bruce M Cohen
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baum); Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge); Butler Hospital Neuromodulation Research Facility, Providence, R.I., and Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Carpenter); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald); Department of Psychiatry and Program for Neuropsychiatric Research, McLean Hospital, Harvard Medical School, Belmont, Mass. (Cohen); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin (Nemeroff)
| | - Charles B Nemeroff
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston (Baum); Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge); Butler Hospital Neuromodulation Research Facility, Providence, R.I., and Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, R.I. (Carpenter); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (McDonald); Department of Psychiatry and Program for Neuropsychiatric Research, McLean Hospital, Harvard Medical School, Belmont, Mass. (Cohen); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin (Nemeroff)
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Milosavljević F, Molden PE, Ingelman-Sundberg PM, Jukić APMM. Current level of evidence for improvement of antidepressant efficacy and tolerability by pharmacogenomic-guided treatment: A Systematic review and meta-analysis of randomized controlled clinical trials. Eur Neuropsychopharmacol 2024; 81:43-52. [PMID: 38340605 DOI: 10.1016/j.euroneuro.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
The aim of the study was to assess the clinical utility of currently available pharmacogenomic (PGx) tools compared with treatment as usual (TAU), using a meta-analysis of dichotomous and continuous antidepressant efficacy and tolerability data from previously published clinical trials. MEDLINE, clinicaltrial.gov, EU Clinical Trials Register, WHO ICTRP and CENTRAL were systematically searched; of the 962 results originally reviewed, 15 trials were included. Antidepressant efficacy was quantified by relative and absolute changes in symptom severity after eight weeks of treatment and by response and remission rates, while tolerability was estimated by the rate of study discontinuation for any reason. In the PGx-guided patients, symptom severity reduced by an average of 31.0% after eight weeks of treatment, compared to an average reduction of 26.8% in the TAU group. Accordingly, PGx-guided patients experienced a greater reduction in symptom severity of 3.4% (95%CI: 1.6-5.3%), which corresponded to a reduction in the Hamilton Depression score of 0.75 (0.30-1.21), a 37% (15-63%) higher remission rate, and an 18% (5-33%) higher response rate compared with TAU patients, while no difference was observed in discontinuation rate between groups. Notably, the majority of associations lost statistical significance when restricting the dataset to low risk of bias studies, while certain funnel plots suggested a potential publication bias favoring the reporting of statistically significant results. In summary, PGx tools marginally enhance antidepressant efficacy, but not antidepressant tolerability; thus, additional research and advancement of PGx tools are needed to improve integration of PGx in clinical pharmacotherapy of depression.
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Affiliation(s)
- Filip Milosavljević
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Prof Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway; Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | | | - Assoc Prof Marin M Jukić
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia; Pharmacogenetics Section, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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Varma R, Staab JP, Matey ET, Wright JA, Deb B, Lazaridis KN, Szarka LA, Bailey KR, Bharucha AE. Most patients with disorders of gut-brain interaction receive pharmacotherapy with major or moderate drug-gene interactions. Neurogastroenterol Motil 2024; 36:e14722. [PMID: 38072827 DOI: 10.1111/nmo.14722] [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] [Received: 06/12/2023] [Revised: 10/25/2023] [Accepted: 11/28/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND How variations predicted by pharmacogenomic testing to alter drug metabolism and therapeutic response affect outcomes for patients with disorders of gut- brain interaction is unclear. AIMS To assess the prevalence of pharmacogenomics-predicted drug-gene interactions and symptom outcomes for patients with disorders of gut-brain interaction. METHODS Patients who were treated in our clinical practice for functional dyspepsia/bowel disorder underwent pharmacogenomic testing. The change in symptoms from baseline to 6 months was compared for patients with variations in CYP2D6 and CYP2C19, which metabolize neuromodulators, and SLC6A4, which encodes the sodium- dependent serotonin transporter. RESULTS At baseline, 79 of 94 participants (84%) had at least one predicted major drug- gene interaction, and all 94 (100%) had at least one predicted moderate interaction. For the 44 participants who completed a survey of their symptoms at 6 months, the mean (SD) irritable bowel syndrome-symptom severity score decreased from 284 (71) at baseline to 231 (95) at 6 months (p < 0.001). Among patients taking selective serotonin reuptake inhibitors, the decrease in symptom severity (p = 0.03) and pain (p = 0.002) scores from baseline to 6 months was greater for patients with a homozygous SLC6A4 long/long genotype (n = 30) (ie, increased serotonin transporter activity) than for patients with homozygous short/short or heterozygous long/short genotypes (n = 64). Symptom outcomes were not affected by CYP2D6 or CYP2C19 variations. CONCLUSIONS The homozygous SLC6A4 long/long genotype confers better symptom resolution for patients with disorders of gut-brain interaction who take selective serotonin reuptake inhibitors than do the homozygous short/short or heterozygous long/short genotypes.
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Affiliation(s)
- Revati Varma
- Research Fellow in the Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric T Matey
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Brototo Deb
- Research Fellow in the Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | | | - Lawrence A Szarka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kent R Bailey
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Pelgrim TAD, Philipsen A, Young AH, Juruena M, Jimenez E, Vieta E, Jukić M, Van der Eycken E, Heilbronner U, Moldovan R, Kas MJH, Jagesar RR, Nöthen MM, Hoffmann P, Shomron N, Kilarski LL, van Amelsvoort T, Campforts B, van Westrhenen R. A New Intervention for Implementation of Pharmacogenetics in Psychiatry: A Description of the PSY-PGx Clinical Study. Pharmaceuticals (Basel) 2024; 17:151. [PMID: 38399366 PMCID: PMC10892863 DOI: 10.3390/ph17020151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background Pharmacological treatment for psychiatric disorders has shown to only be effective in about one-third of patients, as it is associated with frequent treatment failure, often because of side effects, and a long process of trial-and-error pharmacotherapy until an effective and tolerable treatment is found. This notion emphasizes the urgency for a personalized medicine approach in psychiatry. (2) Methods This prospective patient- and rater-blinded, randomized, controlled study will investigate the effect of dose-adjustment of antidepressants escitalopram and sertraline or antipsychotics risperidone and aripiprazole according to the latest state-of-the-art international dosing recommendations for CYP2C19 and CYP2D6 metabolizer status in patients with mood, anxiety, and psychotic disorders. A total sample of N = 2500 will be recruited at nine sites in seven countries (expected drop-out rate of 30%). Patients will be randomized to a pharmacogenetic group or a dosing-as-usual group and treated over a 24-week period with four study visits. The primary outcome is personal recovery using the Recovery Assessment Scale as assessed by the patient (RAS-DS), with secondary outcomes including clinical effects (response or symptomatic remission), side effects, general well-being, digital phenotyping, and psychosocial functioning. (3) Conclusions This is, to our knowledge, the first international, multi-center, non-industry-sponsored randomized controlled trial (RCT) that may provide insights into the effectiveness and utility of implementing pharmacogenetic-guided treatment of psychiatric disorders, and as such, results will be incorporated in already available dosing guidelines.
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Affiliation(s)
- Teuntje A. D. Pelgrim
- Department of Psychiatry, Parnassia Psychiatric Institute, 1062HN Amsterdam, The Netherlands
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, 53105 Bonn, Germany
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road Beckenham, Kent BR3 3BX, UK
| | - Mario Juruena
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road Beckenham, Kent BR3 3BX, UK
| | - Ester Jimenez
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic & Institute of Neurosciences (UBNeuro), IDIBAPS, CIBERSAM, ISCIII, University of Barcelona, 08036 Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clinic & Institute of Neurosciences (UBNeuro), IDIBAPS, CIBERSAM, ISCIII, University of Barcelona, 08036 Catalonia, Spain
| | - Marin Jukić
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia
- Department of Physiology & Pharmacology, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Erik Van der Eycken
- Global Alliance of Mental Illness Advocacy Networks-Europe (GAMIAN-Europe), 1050 Brussels, Belgium
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), LMU University Hospital, LMU Munich, 80336 Munich, Germany
| | - Ramona Moldovan
- Department of Psychology, Babeş-Bolyai University, 400015 Cluj-Napoca, Romania
- Division of Evolution, Infection and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester M13 9PT, UK
- Manchester Center for Genomic Medicine, St. Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Martien J. H. Kas
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, 9700CC Groningen, The Netherlands
| | - Raj R. Jagesar
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, 9700CC Groningen, The Netherlands
| | - Markus M. Nöthen
- Institute of Human Genetics, University Hospital of Bonn and University of Bonn, 53127 Bonn, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University Hospital of Bonn and University of Bonn, 53127 Bonn, Germany
| | - Noam Shomron
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Laura L. Kilarski
- Department of Psychiatry and Psychotherapy, University of Bonn, 53105 Bonn, Germany
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University, 6226NB Maastricht, The Netherlands
| | - Bea Campforts
- Department of Psychiatry and Neuropsychology, Maastricht University, 6226NB Maastricht, The Netherlands
| | | | - Roos van Westrhenen
- Department of Psychiatry, Parnassia Psychiatric Institute, 1062HN Amsterdam, The Netherlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London & South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road Beckenham, Kent BR3 3BX, UK
- Department of Psychiatry and Neuropsychology, Maastricht University, 6226NB Maastricht, The Netherlands
- St. John’s National Academy of Health Sciences, Bangalore 560034, India
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Cheng Y, Liu H, Yuan R, Yuan K, Yu S. Effectiveness of pharmacogenomics on the response and remission of treatment-resistant depression: a meta-analysis of randomised controlled trials. Gen Psychiatr 2023; 36:e101050. [PMID: 38155841 PMCID: PMC10753713 DOI: 10.1136/gpsych-2023-101050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/27/2023] [Indexed: 12/30/2023] Open
Abstract
Background Pharmacogenomics (PGx) is a promising tool to realise tailored drug therapy for depression. Aims To investigate the treatment efficacy of PGx for treatment-resistant depression (TRD) compared with treatment as usual. Methods A systematic search was conducted in PubMed, Embase, the Cochrane Library, Web of Science and PsycINFO to identify relevant studies published from inception to 15 April 2023. Two-arm randomised controlled trials (RCTs) exploring the efficacy of PGx-guided versus unguided treatment for TRD were included. The risk of bias in the included studies was evaluated using the Cochrane risk of bias assessment tool. The overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results Seven RCTs (n=3003) comparing PGx-guided (n=1492) and unguided (n=1511) groups were identified and analysed. PGx-guided treatment was superior to treatment as usual in response (relative risk (RR)=1.31; 95% confidence interval (95% CI): 1.15 to 1.49; p<0.001) and remission (RR=1.40; 95% CI: 1.09 to 1.80; p=0.009) improvements. Effect sizes for acceptability (RR=0.90; 95% CI: 0.80 to 1.02; p=0.100) and side effect burden (RR=0.58; 95% CI: 0.29 to 1.15; p=0.120) between the two groups were not statistically different. The overall quality of evidence was rated from 'very low' (25%) to 'low' (75%) based on the GRADE criteria. Conclusions PGx-guided treatment has shown a small overall effect in improving the response and remission rates for patients with TRD. However, these results should be interpreted cautiously because of the few included studies and the low quality of evidence. Further high-quality clinical trials are warranted to confirm the findings. PROSPERO registration number CRD42022340182.
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Affiliation(s)
- Yu Cheng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongmei Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruixue Yuan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Yuan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shunying Yu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Roberts B, Cooper Z, Lu S, Stanley S, Majda BT, Collins KRL, Gilkes L, Rodger J, Akkari PA, Hood SD. Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review. Front Pharmacol 2023; 14:1267294. [PMID: 37795032 PMCID: PMC10545970 DOI: 10.3389/fphar.2023.1267294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Pharmacogenetics (PGx) is the study and application of how interindividual differences in our genomes can influence drug responses. By evaluating individuals' genetic variability in genes related to drug metabolism, PGx testing has the capabilities to individualise primary care and build a safer drug prescription model than the current "one-size-fits-all" approach. In particular, the use of PGx testing in psychiatry has shown promising evidence in improving drug efficacy as well as reducing toxicity and adverse drug reactions. Despite randomised controlled trials demonstrating an evidence base for its use, there are still numerous barriers impeding its implementation. This review paper will discuss the management of mental health conditions with PGx-guided treatment with a strong focus on youth mental illness. PGx testing in clinical practice, the concerns for its implementation in youth psychiatry, and some of the barriers inhibiting its integration in clinical healthcare will also be discussed. Overall, this paper provides a comprehensive review of the current state of knowledge and application for PGx in psychiatry and summarises the capabilities of genetic information to personalising medicine for the treatment of mental ill-health in youth.
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Affiliation(s)
- Bradley Roberts
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - Zahra Cooper
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Stephanie Lu
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Susanne Stanley
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | | | - Khan R. L. Collins
- Western Australian Department of Health, North Metropolitan Health Service, Perth, WA, Australia
| | - Lucy Gilkes
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
- Divison of General Practice, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Jennifer Rodger
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - P. Anthony Akkari
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia
- Division of Neurology, Duke University Medical Centre, Duke University, Durham, United States
| | - Sean D. Hood
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
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11
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Kleine Schaars K, van Westrhenen R. Pharmacogenomics and the Management of Mood Disorders-A Review. J Pers Med 2023; 13:1183. [PMID: 37511796 PMCID: PMC10381396 DOI: 10.3390/jpm13071183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/13/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
Due to the chronic relapsing nature of mental disorders and increased life expectancy, the societal burden of these non-communicable diseases will increase even further. Treatments for mental disorders, such as depression, are available, but their effect is limited due to patients' (genetic) heterogeneity, low treatment compliance and frequent side effects. In general, only one-third of the patients respond to treatment. Today, medication selection in psychiatry relies on a trial-and-error approach based mainly on physicians' experience. Pharmacogenetic (PGx) testing can help in this process by determining the person-specific genetic factors that may predict clinical response and side effects associated with genetic variants that impact drug-metabolizing enzymes, drug transporters or drug targets. PGxis a discipline that investigates genetic factors that affect the absorption, metabolism, and transport of drugs, thereby affecting therapy outcome. These genetic factors can, among other things, lead to differences in the activity of enzymes that metabolize drugs. Studies in depressed patients show that genotyping of drug-metabolizing enzymes can increase the effectiveness of treatment, which could benefit millions of patients worldwide. This review highlights these studies, gives recommendations and provides future perspectives on how to proceed with PGx testing. Finally, it is recommended to consider genotyping for CYP2D6 and CYP2C19, when there is an indication (side effects or inefficacy).
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Affiliation(s)
- Kristian Kleine Schaars
- Outpatient Clinic Pharmacogenetics, Parnassia Psychiatric Institute/PsyQ, Overschiestraat 57, 1062 HN Amsterdam, The Netherlands
| | - Roos van Westrhenen
- Outpatient Clinic Pharmacogenetics, Parnassia Psychiatric Institute/PsyQ, Overschiestraat 57, 1062 HN Amsterdam, The Netherlands
- Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London SES 8AF, UK
- Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 6161, 6229 ER Maastricht, The Netherlands
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12
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Wang X, Wang C, Zhang Y, An Z. Effect of pharmacogenomics testing guiding on clinical outcomes in major depressive disorder: a systematic review and meta-analysis of RCT. BMC Psychiatry 2023; 23:334. [PMID: 37173736 PMCID: PMC10176803 DOI: 10.1186/s12888-023-04756-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Pharmacogenomic testing guided treatment have been developed to guide drug selection or conversion in major depressive disorder patients. Whether patients benefit from pharmacogenetic testing remains unclear. We aim to evaluates the effect of pharmacogenomic testing guiding on clinical outcomes of major depressive disorder. METHODS Pubmed, Embase, and Cochrane Library of Clinical Trials were searched from inception until August 2022. Key terms included pharmacogenomic and antidepressive. Odds ratios (RR) with 95% confidence intervals (95%CIs) were calculated using fixed-effects model for low or moderate heterogeneity or random-effects model for high heterogeneity. RESULTS Eleven studies (5347 patients) were included. Compared with usual group, pharmacogenomic testing guided group was associated with an increased response rate at week 8 (OR 1.32, 95%CI 1.15-1.53, 8 studies, 4328 participants) and week 12 (OR 1.36, 95%CI 1.15-1.62, 4 studies, 2814 participants). Similarly, guided group was associated with an increased rate of remission at week 8 (OR 1.58, 95%CI 1.31-1.92, 8 studies, 3971 participants) and week 12 (OR 2.23, 95%CI 1.23-4.04, 5 studies, 2664 participants). However, no significant differences were found between the two groups in response rate at week 4 (OR 1.12, 95%CI 0.89-1.41, 2 studies, 2261 participants) and week 24 (OR 1.16, 95%CI 0.96-1.41, 2 studies, 2252 participants), and remission rate at week 4 (OR 1.26, 95%CI 0.93-1.72, 2 studies, 2261 participants) and week 24 (OR 1.06, 95%CI 0.83-1.34, 2 studies, 2252 participants). Medication congruence in 30 days was significantly reduced in the pharmacogenomic guided group compared with the usual care group (OR 2.07, 95%CI 1.69-2.54, 3 studies, 2862 participants). We found significant differences between subgroups of target population in response and remission rate. CONCLUSION Patients with major depressive disorder may benefit from pharmacogenomic testing guided treatment by achieving target response and remission rates more quickly.
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Affiliation(s)
- Xinrui Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Chenfei Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China
| | - Yi Zhang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China.
| | - Zhuoling An
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chaoyang District, Beijing, 100020, China.
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13
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Pharmacokinetic Markers of Clinical Outcomes in Severe Mental Illness: A Systematic Review. Int J Mol Sci 2023; 24:ijms24054776. [PMID: 36902205 PMCID: PMC10003720 DOI: 10.3390/ijms24054776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
The term severe mental illness (SMI) encompasses those psychiatric disorders exerting the highest clinical burden and socio-economic impact on the affected individuals and their communities. Pharmacogenomic (PGx) approaches hold great promise in personalizing treatment selection and clinical outcomes, possibly reducing the burden of SMI. Here, we sought to review the literature in the field, focusing on PGx testing and particularly on pharmacokinetic markers. We performed a systematic review on PUBMED/Medline, Web of Science, and Scopus. The last search was performed on the 17 September 2022, and further augmented with a comprehensive pearl-growing strategy. In total, 1979 records were screened, and after duplicate removal, 587 unique records were screened by at least 2 independent reviewers. Ultimately, forty-two articles were included in the qualitative analysis, eleven randomized controlled trials and thirty-one nonrandomized studies. The observed lack of standardization in PGx tests, population selection, and tested outcomes limit the overall interpretation of the available evidence. A growing body of evidence suggests that PGx testing might be cost-effective in specific settings and may modestly improve clinical outcomes. More efforts need to be directed toward improving PGx standardization, knowledge for all stakeholders, and clinical practice guidelines for screening recommendations.
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14
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Arnone D, Omar O, Arora T, Östlundh L, Ramaraj R, Javaid S, Govender RD, Ali BR, Patrinos GP, Young AH, Stip E. Effectiveness of pharmacogenomic tests including CYP2D6 and CYP2C19 genomic variants for guiding the treatment of depressive disorders: Systematic review and meta-analysis of randomised controlled trials. Neurosci Biobehav Rev 2023; 144:104965. [PMID: 36463971 DOI: 10.1016/j.neubiorev.2022.104965] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Abstract
Major depressive disorders are prevalent conditions with limited treatment response and remission. Pharmacogenomics tests including CYP2D6 and CYP2C19 genomic variants provide the most reliable actionable approach to guide choice and dosing of antidepressants in major depression to improve outcomes. We carried out a meta-analysis and meta-regression analyses of randomised controlled trials evaluating pharmacogenomic tests with CYP2D6 and CYP2C19 polymorphisms in major depression. A systematic review was conducted according to PRISMA and Cochrane guidelines to search several electronic databases. Logarithmically transformed odds ratios (OR) and confidence intervals (CI) for improvement, response and remission were calculated. A random-effects meta-analysis and meta-regression analyses were subsequently carried out. Twelve randomised controlled trials were included. Pharmacogenomic tests in the treatment of depression were more effective than treatment as usual for improvement (OR:1.63, CI: 1.19-2.24), response (OR: 1.46; CI: 1.16-1.85) and remission (OR: 1.85; CI: 1.23-2.76) with no evidence of publication bias. Remission was less favourable in recent studies. The results are promising but cautious use of pharmacogenomics in major depression is advisable. PROSPERO registration ID: CRD42021261143.
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Affiliation(s)
- Danilo Arnone
- Department of Psychiatry, 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, United Kingdom.
| | - Omar Omar
- University of Birmingham, Birmingham Clinical Trials Unit, Birmingham, United Kingdom
| | - Teresa Arora
- Zayed University, College of Natural & Health Sciences, Abu Dhabi, United Arab Emirates
| | | | - Reshma Ramaraj
- Department of Psychiatry, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Syed Javaid
- Department of Psychiatry, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Romona Devi Govender
- Department of Family Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Bassam R Ali
- Department of Genetics and Genomics, United Arab Emirates University, Al Ain, United Arab Emirates
| | - George P Patrinos
- Department of Genetics and Genomics, United Arab Emirates University, Al Ain, United Arab Emirates; Department of Pharmacy, University of Patras School of Health Sciences, Patras, Greece
| | - Allan H Young
- Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emmanuel Stip
- Department of Psychiatry, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; Université de Montreal, Institut Universitaire en Santé Mentale de Montreal, Montreal, Canada
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15
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Jukic M, Milosavljević F, Molden E, Ingelman-Sundberg M. Pharmacogenomics in treatment of depression and psychosis: an update. Trends Pharmacol Sci 2022; 43:1055-1069. [PMID: 36307251 DOI: 10.1016/j.tips.2022.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022]
Abstract
Genetic factors can, to a certain extent, successfully predict the therapeutic effects, metabolism, and adverse reactions of drugs. This research field, pharmacogenomics, is well developed in oncology and is currently expanding in psychiatry. Here, we summarize the latest development in pharmacogenomic psychiatry, where results of several recent large studies indicate a true benefit and cost-effectiveness of pre-emptive genotyping for more successful psychotherapy. However, it is apparent that we still lack knowledge of many additional heritable genetic factors of importance for explanation of the interindividual differences in response to psychiatric drugs. Thus, more effort to further develop pharmacogenomic psychiatry should be invested to achieve a broader clinical implementation.
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Affiliation(s)
- Marin Jukic
- Pharmacogenetics Section, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Department of Physiology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Filip Milosavljević
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Espen Molden
- Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway; Section for Pharmacology and Pharmaceutical Biosciences, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Magnus Ingelman-Sundberg
- Pharmacogenetics Section, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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Brown LC, Stanton JD, Bharthi K, Maruf AA, Müller DJ, Bousman CA. Pharmacogenomic Testing and Depressive Symptom Remission: A Systematic Review and Meta-Analysis of Prospective, Controlled Clinical Trials. Clin Pharmacol Ther 2022; 112:1303-1317. [PMID: 36111494 PMCID: PMC9827897 DOI: 10.1002/cpt.2748] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/11/2022] [Indexed: 01/31/2023]
Abstract
Pharmacogenomic (PGx) testing has emerged as a compelling strategy that clinicians can use to inform antidepressant medication selection and dosing, but the clinical efficacy of this strategy has been questioned. We systematically reviewed and meta-analyzed clinical trials for an association between the use of PGx-guided antidepressant therapy and depressive symptom remission in patients with major depressive disorder (MDD). We included prospective, controlled clinical trials published in English up to July 12, 2022. Data extraction and synthesis adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Each trial was assessed for risk of bias and a random-effects model was used to estimate pooled risk ratios. Thirteen trials comprising 4,767 patients were analyzed, including 10 randomized controlled trials, and three open label trials. Across all included trials, those that received PGx-guided antidepressant therapy (n = 2,395) were 1.41 (95% confidence interval (CI) = 1.15-1.74, P = 0.001) more likely to achieve remission compared with those that received unguided antidepressant therapy (n = 2,372). Pooled risk ratios for randomized controlled trials and open label trials were 1.46 (95% CI: 1.13-1.88) and 1.26 (95% CI = 0.84-1.88), respectively. These results suggest that PGx-guided antidepressant therapy is associated with a modest but significant increase in depressive symptom remission in adults with MDD. Efforts to address the heterogeneity in PGx test composition (i.e., genes and alleles tested) and accompanying prescribing recommendations across trials will likely reduce the uncertainty about the efficacy of PGx-guided antidepressant therapy in the literature.
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Affiliation(s)
| | | | - Kanika Bharthi
- Department of Biological SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Abdullah Al Maruf
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,College of Pharmacy, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada,Children's Hospital Research Institute of ManitobaWinnipegManitobaCanada
| | - Daniel J. Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research InstituteCentre for Addiction and Mental HealthTorontoOntarioCanada,Department of PsychiatryUniversity of TorontoTorontoOntarioCanada,Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental HealthUniversity Hospital of WürzburgWürzburgGermany
| | - Chad A. Bousman
- The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada,Departments of Medical Genetics, Psychiatry, Physiology and Pharmacology, and Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada,Alberta Children's Hospital Research InstituteUniversity of CalgaryCalgaryAlbertaCanada
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17
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Young AH. The Journal of Psychopharmacology: La Plus ça change. . J Psychopharmacol 2021; 35:887-889. [PMID: 34318728 DOI: 10.1177/02698811211036951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Allan H Young
- Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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