Effect of Pharmacogenetic-Based Decision Support Tools in Improving Depression Outcomes: A Systematic Review

Abstract

Introduction: Evidence supporting pharmacogenetic (PGX) tests utility in depression is scarce. The main objectives of this study were to summarize, update, and assess the quality of the available evidence regarding PGX testing in depression as well as estimating the impact of using PGX testing tools in depression outcomes in the MENA region. Methodology: Scientific databases were systematically searched from inception to March 20, 2020 for systematic reviews (SRs) and randomized controlled trials (RCTs) assessing clinical utility of PGX tests in treatment of depression. Meta-analysis only and RCTs that that were included in eligible SRs were excluded. Quality of the eligible studies were assessed using Crowe Critical Appraisal Tool (CCAT). Results: Six SRs and three RCTs met the inclusion criteria and were included in this study. Results of the SRs have provided weak evidence on the efficacy of PGX testing especially in patients with moderate-severe depression at eight weeks. In addition, there was a lack of evidence regarding safety outcomes. Newer RCTs with better qualities showed clinical promise regarding efficacy outcomes especially in patients with gene-drug interactions. No evidence was found regarding PGX testing impact in the MENA region. Conclusion: This SR summarizes findings, provides an update, and assesses the quality of available SRs on this topic. Findings of this study have demonstrated that PGX testing prior to treatment initiation might improve efficacy outcomes. Further studies are warranted to assess PGX testing impact on safety outcomes.

Single-Nucleotide Polymorphisms, c.415C > T (Arg139Cys) and c.416G > A (Arg139His), in the <i>NUDT15</i> Gene Are Associated with Thiopurine-Induced Leukopenia

“…A number of basic and clinical studies have already demonstrated the association between gene polymorphisms of pharmacokinetic factors, such as drug metabolizing enzymes and drug efficacies, and the evidence for personalized medicine has been accumulating. [1][2][3][4] It has also been reported that there is a large variation in the frequency of gene polymorphisms among different races. 5) Thiopurine drugs, specifically azathioprine and 6-mercaptopurine, are some of the few drugs that can be used for the maintenance of remission in inflammatory bowel disease (IBD), [6][7][8][9] and the number of IBD patients has increased dramatically in recent years.…”