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

Perlis, Roy H.; Mehta, Rajesh; Edwards, Alison; Tiwari, Arun; Imbens, Guido W.

doi:10.1002/da.22742

Cited by 38 publications

(43 citation statements)

References 9 publications

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“…These results, which contrast with two prior nonrandomized cost‐effectiveness studies of this assay using health claims data (Fagerness et al, 2014; Perlis et al, 2018), must also be interpreted in the context of prior randomized trials, all single‐blind and either 8 or 12 weeks. In particular, while two 12‐week studies were positive (Singh, 2015), two recent studies yielded negative results on their primary outcome measures, including a recent study enrolling more than 1,100 participants (Greden et al, 2019; Pérez et al, 2017) These latter studies did demonstrate benefit on some secondary measures.…”

Section: Discussionmentioning

confidence: 59%

“…Naturalistic cost‐effectiveness studies likewise suggest that testing for common genetic variation may be associated with improved treatment outcomes. For example, two prior studies using a commercial test found economically meaningful and statistically significant reduction in health care utilization over 4 or 6 months (Fagerness, Fonseca, & Hess, 2014; Perlis, Mehta, Edwards, Tiwari, & Imbens, 2018).…”

Section: Introductionmentioning

confidence: 99%

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Randomized, controlled, participant‐ and rater‐blind trial of pharmacogenomic test‐guided treatment versus treatment as usual for major depressive disorder

Perlis

Dowd²,

Fava

et al. 2020

Depression and Anxiety

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Background Cohort and cost‐effectiveness studies suggest that measuring variation in genes that influence metabolism of common drugs could improve antidepressant treatment outcomes. Prior randomized trials have yielded inconsistent results. Method Multicenter randomized double‐blind (subject and rater), controlled trial of pharmacogenomic testing among outpatients with nonpsychotic major depressive disorder. Study participants (n = 304) were randomized 1:1 to assay‐guided treatment (AGT; N = 151) or treatment‐as‐usual (TAU; N = 153). Participants and raters were blinded to study arm; unblinded clinicians received results of a pharmacogenomic test and adjusted treatment in light of the test report. Primary outcome was change over 8 weeks in Hamilton Depression Rating Scale (SIGH‐D‐17). Results For the primary comparison of interest, change in SIGH‐D‐17, no significant difference was detected between AGT and TAU at Week 8 (p = .53). Rates of study completion also did not differ between the arms (AGT 92.7%, TAU 92.2% (χ2 = 0.03, df = 1, p = .86). Exploratory analyses suggested significantly fewer individuals experienced worsening of depressive symptoms following AGT, and that treatment concordant with assay results was associated with greater likelihood of remission. Conclusion Pharmacogenomic testing using a panel of pharmacokinetic and pharmacodynamic variants was not associated with significant improvement in the primary efficacy outcome when providers were unconstrained by the assay results. Further investigation is needed to understand the discordance with cost‐effectiveness results and among randomized trials.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Randomized, controlled, participant‐ and rater‐blind trial of pharmacogenomic test‐guided treatment versus treatment as usual for major depressive disorder

Perlis

Dowd²,

Fava

et al. 2020

Depression and Anxiety

Self Cite

View full text Add to dashboard Cite

show abstract

“…To date, almost all prospective PGx studies have included patients with MDD who have failed 1 medication trial and inclusion/exclusion criteria are relatively broad, but similar across trials. Finally, most PGx data have been synthesized from retrospective studies and retrospective studies of specific commercial PGx tests have also been performed in order to show clinical validity and economic utility[55][56][57][58][59][60][61][62][63]. It is therefore beneficial for PGx testing to have various trial designs supporting its use in psychiatry.…”

mentioning

confidence: 99%

Clinical Utilization of Pharmacogenetics in Psychiatry – Perspectives of Pharmacists, Genetic Counselors, Implementation Science, Clinicians, and Industry

et al. 2019

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Introduction The use of pharmacogenomic (PGx) testing to guide decisions and improve patient outcomes has increased in recent years. PGx testing represents a decision support tool that may inform dosing, increase the likelihood of treatment response, and identify patients at risk for medication side effects. Methods This is a narrative review of utilization of PGx testing in psychiatry from stakeholders including, pharmacists, genetic counselors, implementation scientists, industry, and clinicians. Results While many limitations exist to streamline use of PGx testing in psychiatry, various stakeholders are crucial to clinical implementation. Discussion PGx testing can assist in medication selection and improve patient outcomes; however, more data are needed to understand when and how to incorporate PGx testing into psychiatric practice.

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“…In contrast, the validation of the effectiveness of medications by PGx incentivizes patients towards improved medication adherence [6]. From the perspective of the payer, more health insurance companies are realizing the financial benefits of PGx testing, which decreases unnecessary utilization and costs, and are thus reimbursing for PGx tests [7]. Furthermore, patients have a desire to manage and share PGx results with family members.…”

Section: Introductionmentioning

confidence: 99%

Pharmacogenomics cascade testing (PhaCT): a novel approach for preemptive pharmacogenomics testing to optimize medication therapy

2020

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The implementation of pharmacogenomics (PGx) has come a long way since the dawn of utilizing pharmacogenomic data in clinical patient care. However, the potential benefits of sharing PGx results have yet to be explored. In this paper, we explore the willingness of patients to share PGx results, as well as the inclusion of family medication history in identifying potential family members for pharmacogenomics cascade testing (PhaCT). The genetic similarities in families allow for identifying potential gene variants prior to official preemptive testing. Once a candidate patient is determined, PhaCT can be initiated. PhaCT recognizes that further cascade testing throughout a family can serve to improve precision medicine. In order to make PhaCT feasible, we propose a novel shareable HIPAA-compliant informatics platform that will enable patients to manage not only their own test results and medications but also those of their family members. The informatics platform will be an external genomics system with capabilities to integrate with patients' electronic health records. Patients will be given the tools to provide information to and work with clinicians in identifying family members for PhaCT through this platform. Offering patients the tools to share PGx results with their family members for preemptive testing could be the key to empowering patients. Clinicians can utilize PhaCT to potentially improve medication adherence, which may consequently help to distribute the burden of health management between patients, family members, providers, and payers.

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

Abstract: Pharmacogenetic testing represents a promising strategy to reduce costs and utilization among patients with mood and anxiety disorders.

Cited by 38 publications

References 9 publications

Randomized, controlled, participant‐ and rater‐blind trial of pharmacogenomic test‐guided treatment versus treatment as usual for major depressive disorder

Randomized, controlled, participant‐ and rater‐blind trial of pharmacogenomic test‐guided treatment versus treatment as usual for major depressive disorder

Clinical Utilization of Pharmacogenetics in Psychiatry – Perspectives of Pharmacists, Genetic Counselors, Implementation Science, Clinicians, and Industry

Pharmacogenomics cascade testing (PhaCT): a novel approach for preemptive pharmacogenomics testing to optimize medication therapy

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