UMMS Affiliation

Department of Psychiatry

Publication Date

2019-04-01

Document Type

Article

Disciplines

Health Services Administration | Health Services Research | Medical Pharmacology | Medicinal Chemistry and Pharmaceutics | Mental and Social Health | Mental Disorders | Pharmaceutical Preparations | Pharmacy and Pharmaceutical Sciences | Psychiatry | Therapeutics

Abstract

Current prescribing practices for major depressive disorder (MDD) produce limited treatment success. Although pharmacogenomics may improve outcomes by identifying genetically inappropriate medications, studies to date were limited in scope. Outpatients (N=1167) diagnosed with MDD and with a patient- or clinician-reported inadequate response to at least one antidepressant were enrolled in the Genomics Used to Improve DEpression Decisions (GUIDED) trial - a rater- and patient-blind randomized controlled trial. Patients were randomized to treatment as usual (TAU) or a pharmacogenomics-guided intervention arm in which clinicians had access to a pharmacogenomic test report to inform medication selections (guided-care). Medications were considered congruent ('use as directed' or 'use with caution' test categories) or incongruent ('use with increased caution and with more frequent monitoring' test category) with test results. Unblinding occurred after week 8. Primary outcome was symptom improvement [change in 17-item Hamilton Depression Rating Scale (HAM-D17)] at week 8; secondary outcomes were response ( > /=50% decrease in HAM-D17) and remission (HAM-D17 < /=7) at week 8. At week 8, symptom improvement for guided-care was not significantly different than TAU (27.2% versus 24.4%, p=0.107); however, improvements in response (26.0% versus 19.9%, p=0.013) and remission (15.3% versus 10.1%, p=0.007) were statistically significant. Patients taking incongruent medications prior to baseline who switched to congruent medications by week 8 experienced greater symptom improvement (33.5% versus 21.1%, p=0.002), response (28.5% versus 16.7%, p=0.036), and remission (21.5% versus 8.5%, p=0.007) compared to those remaining incongruent. Pharmacogenomic testing did not significantly improve mean symptoms but did significantly improve response and remission rates for difficult-to-treat depression patients over standard of care (ClinicalTrials.gov NCT02109939).

Keywords

major depressive disorder, pharmacogenomics

Rights and Permissions

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).

DOI of Published Version

10.1016/j.jpsychires.2019.01.003

Source

J Psychiatr Res. 2019 Apr;111:59-67. doi: 10.1016/j.jpsychires.2019.01.003. Epub 2019 Jan 4. Link to article on publisher's site

Journal/Book/Conference Title

Journal of psychiatric research

Comments

Full author list omitted for brevity. For the full list of authors, see article.

Related Resources

Link to Article in PubMed

PubMed ID

30677646

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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