Early Adoption of Pharmacogenetic Testing for Veterans Prescribed Psychotropic Medications

Hull, Leland E.; Chanfreau‐Coffinier, Catherine; Tuteja, Sony; Berlowitz, Dan R.; Lehmann, Lisa Soleymani; Oslin, David W.; Pyne, Jeffrey M.; DuVall, Scott L.; Lynch, Julie

doi:10.2217/pgs-2019-0065

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…While others have examined PGX in veterans retrospectively using the pharmacy records (Hull et al, 2019), ours is the first prospective study to examine the use of PGX in this group. We found in this prospective PGX implementation study trend-level support for the utility of PGX relative to TAU in veterans with TRD.…”

Section: Discussionmentioning

confidence: 99%

A prospective study to determine the clinical utility of pharmacogenetic testing of veterans with treatment-resistant depression

et al. 2021

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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. Aim: To determine the efficacy of genetically guided pharmacological treatment of TRD. 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). 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. Conclusions: The data reveal possible group differences in the utility of PGX testing in veterans with TRD. ClinicalTrials.gov Identifier: NCT04469322.

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Section: Discussionmentioning

confidence: 99%

A prospective study to determine the clinical utility of pharmacogenetic testing of veterans with treatment-resistant depression

et al. 2021

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Documentation of results and medication prescribing after combinatorial psychiatric pharmacogenetic testing: A case for discrete results

Loftus,

Levy,

Stevenson

2024

Genetics in Medicine

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The Advisory Group on Risk Evidence Education for Dementia: Multidisciplinary and Open to All

Rosen

Arias

Ashford

et al. 2022

JAD

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The brain changes of Alzheimer’s disease and other degenerative dementias begin long before cognitive dysfunction develops, and in people with subtle cognitive complaints, clinicians often struggle to predict who will develop dementia. The public increasingly sees benefits to accessing dementia risk evidence (DRE) such as biomarkers, predictive algorithms, and genetic information, particularly as this information moves from research to demonstrated usefulness in guiding diagnosis and clinical management. For example, the knowledge that one has high levels of amyloid in the brain may lead one to seek amyloid reducing medications, plan for disability, or engage in health promoting behaviors to fight cognitive decline. Researchers often hesitate to share DRE data, either because they are insufficiently validated or reliable for use in individuals, or there are concerns about assuring responsible use and ensuring adequate understanding of potential problems when one’s biomarker status is known. Concerns include warning people receiving DRE about situations in which they might be compelled to disclose their risk status potentially leading to discrimination or stigma. The Advisory Group on Risk Evidence Education for Dementia (AGREEDementia) welcomes all concerned with how best to share and use DRE. Supporting understanding in clinicians, stakeholders, and people with or at risk for dementia and clearly delineating risks, benefits, and gaps in knowledge is vital. This brief overview describes elements that made this group effective as a model for other health conditions where there is interest in unfettered collaboration to discuss diagnostic uncertainty and the appropriate use and communication of health-related risk information.

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Early Adoption of Pharmacogenetic Testing for Veterans Prescribed Psychotropic Medications

Cited by 3 publications

References 17 publications

A prospective study to determine the clinical utility of pharmacogenetic testing of veterans with treatment-resistant depression

A prospective study to determine the clinical utility of pharmacogenetic testing of veterans with treatment-resistant depression

Documentation of results and medication prescribing after combinatorial psychiatric pharmacogenetic testing: A case for discrete results

The Advisory Group on Risk Evidence Education for Dementia: Multidisciplinary and Open to All

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