A Naturalistic Study of the Effectiveness of Pharmacogenetic Testing to Guide Treatment in Psychiatric Patients With Mood and Anxiety Disorders

Brennan, Francis X.; Gardner, Kathryn R.; Lombard, Jay; Perlis, Roy H.; Fava, Maurizio; Harris, H. W.; Scott, Rachel

doi:10.4088/pcc.14m01717

Cited by 31 publications

(33 citation statements)

References 40 publications

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“…In comparison, the commercial pharmacogenetic Genecept Assay includes polymorphisms in CYP2D6, CYP2C19, CYP3A4, SLC6A4, HTR2C, DRD2, CACNA1C, ANK3, COMT, MTHFR, MC4R, ADRA2A, BDNF, OPRM1 and GRIK1. This assay was tested in a naturalistic study (Brennan et al 2015) that did not include a comparison arm receiving treatment as usual, thus statements regarding the clinical benefits of the test are particularly difficult. A study that did include patients treated as usual reported higher medication adherence and cost sav-ings in patients who underwent the test (Fagerness et al 2014).…”

Section: Clinical Applications: Pilot Studiesmentioning

confidence: 99%

Consensus paper of the WFSBP Task Force on Genetics: Genetics, epigenetics and gene expression markers of major depressive disorder and antidepressant response

Fabbri

Hosák

Mößner

et al. 2016

The World Journal of Biological Psychiatry

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Major depressive disorder (MDD) is a heritable disease with a heavy personal and socio-economic burden. Antidepressants of different classes are prescribed to treat MDD, but reliable and reproducible markers of efficacy are not available for clinical use. Further complicating treatment, the diagnosis of MDD is not guided by objective criteria, resulting in the risk of under-or overtreatment. A number of markers of MDD and antidepressant response have been investigated at the genetic, epigenetic, gene expression and protein levels. Polymorphisms in genes involved in anti-depressant metabolism (cytochrome P450 isoenzymes), antidepressant transport (ABCB1), glucocorticoid signalling (FKBP5) and serotonin neurotransmission (SLC6A4 and HTR2A) were among those included in the first pharmacogenetic assays that have been tested for clinical applicability. The results of these investigations were encouraging when examining patient-outcome improvement. Furthermore, a nine-serum biomarker panel (including BDNF, cortisol and soluble TNF-a receptor type II) showed good sensitivity and specificity in differentiating between MDD and healthy controls. These first diagnostic and response-predictive tests for MDD provided a source of optimism for future clinical applications. However, such findings should be considered very carefully because their benefit/cost ratio and clinical indications were not clearly demonstrated. Future tests may include combinations of different types of biomarkers and be specific for MDD subtypes or pathological dimensions.

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Section: Clinical Applications: Pilot Studiesmentioning

confidence: 99%

Consensus paper of the WFSBP Task Force on Genetics: Genetics, epigenetics and gene expression markers of major depressive disorder and antidepressant response

Fabbri

Hosák

Mößner

et al. 2016

The World Journal of Biological Psychiatry

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“…Evidence to date suggests there may be potential benefits associated with the use of pharmacogenetic decision support tools, such as increased remission rates [36,[46][47][48], reduced adverse effects [36,49], and cost-savings [36,[50][51][52]. However, the clinical utility of these tools remains uncertain due to a lack of high quality randomized clinical trials with adequate statistical power.…”

Section: ) Do You Have Good Reason To Believe That Yourmentioning

confidence: 99%

Antidepressant Prescribing in the Precision Medicine Era: a Prescriber's Primer on Pharmacogenetic Tools

Bousman¹,

Forbes²,

Jayaram³

et al. 2018

FOC

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About half of people who take antidepressants do not respond and many experience adverse effects. These detrimental outcomes are in part a result of the impact of an individual's genetic profile on pharmacokinetics and pharmcodynamics. If known and made available to clinicians, this could improve decision-making and antidepressant therapy outcomes. This has spurred the development of numerous pharmacogenetic-based decision support tools. In this article, we provide an overview of pharmacogenetic decision support tools, with particular focus on tools relevant to antidepressants. We briefly describe the evolution and current state of antidepressant pharmacogenetic decision support tools in clinical practice, followed by the evidence-base for their use. Finally, we present a series of considerations for clinicians contemplating use of these tools and discuss the future of antidepressant pharmacogenetic decision support tools.

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“…Small cohort studies have suggested that comprehensive assays integrating CYP450 variation with pharmacodynamic variation may be associated with improved global outcomes in depression or in psychiatric outpatients more generally (Brennan et al, 2015). Small cohort studies have suggested that comprehensive assays integrating CYP450 variation with pharmacodynamic variation may be associated with improved global outcomes in depression or in psychiatric outpatients more generally (Brennan et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…This list includes 27 medications commonly used in psychiatric practice to treat mood and anxiety disorders. Small cohort studies have suggested that comprehensive assays integrating CYP450 variation with pharmacodynamic variation may be associated with improved global outcomes in depression or in psychiatric outpatients more generally (Brennan et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Pharmacogenetic testing among patients with mood and anxiety disorders is associated with decreased utilization and cost: A propensity-score matched study

Perlis

Mehta²,

Edwards³

et al. 2018

Depress Anxiety

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A Naturalistic Study of the Effectiveness of Pharmacogenetic Testing to Guide Treatment in Psychiatric Patients With Mood and Anxiety Disorders

Abstract: ClinicalTrials.gov identifier: NCT01507155.

Cited by 31 publications

References 40 publications

Consensus paper of the WFSBP Task Force on Genetics: Genetics, epigenetics and gene expression markers of major depressive disorder and antidepressant response

Consensus paper of the WFSBP Task Force on Genetics: Genetics, epigenetics and gene expression markers of major depressive disorder and antidepressant response

Antidepressant Prescribing in the Precision Medicine Era: a Prescriber's Primer on Pharmacogenetic Tools

Pharmacogenetic testing among patients with mood and anxiety disorders is associated with decreased utilization and cost: A propensity-score matched study

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