Medication Optimization Using Pharmacogenomic Testing in a Complex Mental Health Population Prescribed Psychiatric Polypharmacy

Abstract

The use of polypharmacy has become significantly more common over the past two decades, increasing the risk of drug-drug interactions and adverse drug reactions. Pharmacogenomic (PGx) assays have the purported benefit of being able to predict an individual's response to a specific medication based on genetic markers, which may facilitate the development of optimized medication regimens for patients prescribed polypharmacy. This 12-week pilot study examined the impact of the PGx results on the clinical management of Veterans who were prescribed psychiatric polypharmacy. Psychiatric medication providers were given access to the PGx assay results, including notification of drug-drug-gene interactions computed from an algorithm decision tool, to assist with medication management decisions. Veteran outpatients (N = 53) prescribed polypharmacy (mean = 13.15 medications) were enrolled into the study. In 92.4% of cases, providers changed medications at baseline, with 83% of providers indicating that they changed their original medication plan based on the PGx results. Clinical improvement over the 12-week treatment phase was seen in depression (F(1.63, 45) = 5.45, P = .01, η 2 = .11) and mental health quality of life (F(2.00, 45) = 4.16, P < .05, η 2 = .16). Adverse drug effects were unchanged or improved over time. Rates of polypharmacy remained unchanged. The results suggest that medication changes based on the PGx assay may be beneficial in a complex patient population prescribed polypharmacy.

Pharmacogenomic Testing to Guide Treatment of Major Depressive Disorder: A Systematic Review

“…Characteristics of the 22 studies are listed in Table 2. Six of the included studies were prospective cohort trials [8][9][10][11][12][13]; four of these studies did not include a control arm and only evaluated PGx-guided treatment [10][11][12][13]. The rest were randomized-controlled trials.…”

The Contribution of Genetic Testing in Optimizing Therapy for Patients with Recurrent Depressive Disorder

“…According to this research, the employment of pharmacogenetic tests to guide therapeutic choices is recommendable and even mandatory to guide treatment for MDD and/or anxiety, especially when the patient’s previous treatment has failed [ 39 ]. The works of Wood et al [ 41 ] and King et al [ 42 ] support these arguments, showing similar results (but in a different research line) concerning the beneficial effects of drug optimization based on PGx testing, resulting in the alleviation of symptoms in depressive patients (F(1.63, 45) = 5.45, p = 0.01, η 2 = 0.11) along with mental health improvements (F(2.00, 45) = 4.16, p < 0.05, η 2 = 0.16) and fewer side effects.…”

“…Furthermore, the Genomind testing results and treatment recommendations, along with the clinical guideline recommendations provided by organizations such as the Drug–Gene Pair Working Group (DWPG) and the Clinical Pharmacogenetics Implementation Consortium (CPIC), recommend PGx testing, since genetic variation may influence the recommended dose, efficiency, and safety profile of various antidepressants. For example, CYP2D6, CYP2C19, and CYP2B6 strongly influence the metabolism of several antidepressant drugs [ 40 , 41 , 42 ]. Moreover, pharmacodynamic genes can be used to explore the efficacy and side effects of these drugs.…”

“…Moreover, pharmacodynamic genes can be used to explore the efficacy and side effects of these drugs. The aim of the Clinical Pharmacogenetics Implementation Consortium (CPIC) is to update and extend the indications of pharmacogenetic testing [ 41 ]. In 2021, Brouwer et al published the Dutch Pharmacogenetics Working Group (DPWG) guidelines, which present the gene–drug interactions for the genes CYP2C19 and CYP2D6 and SSRIs, concluding that genotyping should be recommended to each patient before starting antidepressant therapy [ 24 , 25 , 43 ].…”

Multigenetic Pharmacogenomics–Guided Treatment vs Treatment As Usual Among Hospitalized Men With Schizophrenia

“… 11 By detecting these variations, pharmacogenomic testing can provide valuable information for medication selection and dose adjustment in clinical practice. Several commercial multigenetic pharmacogenomic tests, such as GeneSight 12 and Genecept, 13 have been developed and implemented in the clinical practice of psychiatry. These tests detect a combination of several genes and provide reports on drug recommendations using proprietary algorithms, 14 which were found to perform better than single-variant testing in terms of predicting outcomes.…”