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Ahmed AT, Biernacka JM, Jenkins G, Rush AJ, Shinozaki G, Veldic M, Rung S, Bobo WV, Hall-Flavin DK, Weinshilboum RM, Wang L, Frye MA. Pharmacokinetic-Pharmacodynamic interaction associated with venlafaxine-XR remission in patients with major depressive disorder with history of citalopram / escitalopram treatment failure. J Affect Disord 2019; 246:62-68. [PMID: 30578947 PMCID: PMC6501809 DOI: 10.1016/j.jad.2018.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/08/2018] [Accepted: 12/15/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to identify specific pharmacokinetic (PK) and pharmacodynamics (PD) factors that affect the likelihood of treatment remission with a serotonin norepinephrine reuptake inhibitor (SNRI) in depressed patients whose initial selective serotonin reuptake inhibitor (SSRI) failed. METHODS Multiple logistic regression modeling of PK and PD variation hypothesized to contribute to SNRI (i.e. duloxetine or venlafaxine) treatment remission in prior SSRI (i.e. citalopram or escitalopram) failure was conducted on 139 subjects from the Pharmacogenomics Research Network (PGRN) and Sequenced Treatment Alternatives to Relieve Depression (STAR*D) studies. Depressive symptoms were assessed with the Quick Inventory of Depressive Symptomatology Clinician-rated (QIDS-C16). RESULTS Venlafaxine-XR remission was associated with a significant interaction between CYP2D6 ultra-rapid metabolizer (URM) phenotype and SLC6A4 5-HTTLPR L/L genotype. A similar significant interaction effect was observed between CYP2D6 URM and SLC6A2 G1287A GA genotype. Stratifying by transporter genotypes, venlafaxine-XR remission was associated with CYP2D6 URM in patients with SLC6A4 L/L (p = 0.001) and SLC6A2 G1287A GA genotypes. LIMITATIONS The primary limitation of this post hoc study was small sample size. CONCLUSION Our results suggest that CYP2D6 ultra-rapid metabolizer status contributes to venlafaxine-XR treatment remission in MDD patients; in particular, there is a PK-PD interaction with treatment remission associated with CYP2D6 URM phenotype and SLC6A4 5-HTTLPR L/L or SLC6A2 G1287A G/A genotype, respectively. These preliminary data are encouraging and support larger pharmacogenomics studies differentiating treatment response to mechanistically different antidepressants in addition to further PK-PD interactive analyses.
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Affiliation(s)
- Ahmed T. Ahmed
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States
| | - Joanna M. Biernacka
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Gregory Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - A John Rush
- Duke-National University of Singapore, Singapore,Department of Psychiatry, Duke Medical School, Durham, NC, United States,Texas Tech University-Health Sciences Center, Permian Basin, TX, United States
| | - Gen Shinozaki
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States
| | - Simon Rung
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States
| | - William V. Bobo
- Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa, United States,Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL, United States
| | | | - Richard M. Weinshilboum
- Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
| | - Liewei Wang
- Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States
| | - Mark A. Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States,Corresponding author (M.A. Frye)
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