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A prospective study to determine the clinical utility of pharmacogenetic testing of veterans with treatment-resistant depression.
- Source :
-
Journal of psychopharmacology (Oxford, England) [J Psychopharmacol] 2021 Aug; Vol. 35 (8), pp. 992-1002. Date of Electronic Publication: 2021 May 03. - Publication Year :
- 2021
-
Abstract
- Background: Pharmacotherapies for depression are often ineffective and treatment-resistant depression (TRD) is common across bipolar disorder (BD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD). Patient genetic information can be used to predict treatment outcomes. Prospective studies indicate that pharmacogenetic (PGX) tests have utility in the treatment of depression. However, few studies have examined the utility of PGX in other diagnoses typified by depression, or in veterans, a cohort with high rates of medical comorbidity, social stress, and suicide.<br />Aim: To determine the efficacy of genetically guided pharmacological treatment of TRD.<br />Methods: We conducted an 8-week, prospective, multisite, single-blind study in 182 veterans with TRD including patients with BD, MDD, and PTSD. Subjects were randomly assigned to PGX-guided treatment in which the clinician incorporated PGX information into decision-making, or treatment as usual (TAU).<br />Results: Overall, the PGX group improved marginally faster compared to TAU, but the difference was not statistically significant. Secondary analyses revealed that only PTSD patients showed a potential benefit from PGX testing. Patients predicted by PGX testing to have moderate levels of genetic risk showed a significant benefit from the PGX-guided treatment, whereas other risk groups demonstrated no benefit. Clinicians generally found the PGX test was useful, particularly in more depressed patients and/or those with more warnings for significant or serious adverse outcomes. Clinicians more often used the results to select a drug, but only rarely to adjust dosing.<br />Conclusions: The data reveal possible group differences in the utility of PGX testing in veterans with TRD.ClinicalTrials.gov Identifier: NCT04469322.
- Subjects :
- Adult
Aged
Aged, 80 and over
Antidepressive Agents administration & dosage
Bipolar Disorder genetics
Cohort Studies
Depressive Disorder, Major genetics
Depressive Disorder, Treatment-Resistant genetics
Female
Humans
Male
Middle Aged
Pharmacogenetics
Prospective Studies
Single-Blind Method
Stress Disorders, Post-Traumatic genetics
Treatment Outcome
Veterans
Young Adult
Bipolar Disorder drug therapy
Depressive Disorder, Major drug therapy
Depressive Disorder, Treatment-Resistant drug therapy
Pharmacogenomic Testing methods
Stress Disorders, Post-Traumatic drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1461-7285
- Volume :
- 35
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of psychopharmacology (Oxford, England)
- Publication Type :
- Academic Journal
- Accession number :
- 33938307
- Full Text :
- https://doi.org/10.1177/02698811211015224