Torrellas Clara, Carril Juan Carlos, Cacabelos Ramón
EuroEspes Biomedical Research Center, Institute of Medical Sciences and Genomic Medicine, 15165-Bergondo, Corunna, Spain.
Chair of Genomic Medicine, Camilo José Cela University, 28692- Madrid, Spain.
Curr Genomics. 2017 Oct;18(5):442-449. doi: 10.2174/1389202918666170426164940.
The response rate in the pharmacological treatment of depression has been estimated to be around 50%, achieving a remission in symptomatology in only one third of the patients. Suboptimal prescription of antidepressants has been proposed as a significant explanatory factor for this therapeutic inefficacy. The use of pharmacogenetic testing might favor the optimization of pharmacotherapy in emotional disorders. However, its implementation in the clinical routine requires studies which prove its efficacy.
The aim is to explore the clinical effects obtained by means of the personalization of antidepressant treatment derived from the pharmacogenetic profile of the individual.
A sample of 291 patients under antidepressant treatment was selected, and these patients were genotyped for the most common polymorphisms of the CYP2D6, CYP2C9, CYP2C19 and CYP3A4/5 genes using RT-PCR and TaqMan® technology. 30 of them were subjected to psycho-affective assessment using the HDRS scale before and after a process of individualization of their psychopharmacological treatment in accordance with the genotype obtained.
70% of the individuals treated using the traditional criterion of trial-and-error were not taking the active ingredient most suited to their pharmacogenetic profile. The inclusion of this genetic information in the choice of drug and its dosage entailed a significant, progressive reduction in depressive symptomatology, with an efficacy ratio of 80% and a remission of the pathology in almost 30% of the cases.
These results suggest that the prescription of pharmacogenetic profile-based strategies has a positive effect on the therapeutic response to antidepressants.
据估计，抑郁症药物治疗的有效率约为50%，仅三分之一的患者症状得到缓解。抗抑郁药处方不当被认为是治疗无效的一个重要解释因素。药物遗传学检测的应用可能有助于优化情感障碍的药物治疗。然而，在临床常规中实施该检测需要有研究证明其有效性。
旨在探讨根据个体药物遗传学特征进行抗抑郁治疗个体化所获得的临床效果。
选取291例接受抗抑郁治疗的患者作为样本，采用RT-PCR和TaqMan®技术对这些患者的CYP2D6、CYP2C9、CYP2C19和CYP3A4/5基因的最常见多态性进行基因分型。其中30例患者在根据获得的基因型进行精神药理学治疗个体化过程前后，使用汉密尔顿抑郁量表（HDRS）进行心理情感评估。
采用传统试错标准治疗的患者中，70%未使用最适合其药物遗传学特征的活性成分。在药物选择及其剂量中纳入这种基因信息，可使抑郁症状显著逐步减轻，有效率达80%，近30%的病例病情缓解。
这些结果表明，基于药物遗传学特征的治疗策略处方对抗抑郁药的治疗反应有积极影响。
