Department of Psychiatry, Segovia de Arana Health Research Institute (IDIPHISA)-Puerta de Hierro University Hospital, Avenida Manuel de Falla s/n, Majadahonda, Madrid, Spain.
Autonoma University, Madrid, Spain.
J Neural Transm (Vienna). 2019 Jan;126(1):101-107. doi: 10.1007/s00702-018-1882-4. Epub 2018 Apr 6.
This is a retrospective cohort study of 20 children and adolescents to evaluate the clinical utility of a pharmacogenetic decision support tool. Twenty children and adolescents underwent pharmacogenetic testing between June 2014 and May 2017. All children and adolescents were evaluated at Puerta de Hierro University Hospital-Majadahonda (Madrid, Spain). We report the proportion of patients achieving clinical improvement, amelioration of side effects, and changes in number of drugs. Data normality was assessed with the Shapiro-Wilk test, and changes of pre- and post-pharmacogenetic testing were analyzed with the Wilcoxon test for paired samples. A two-sided p value threshold of 0.05 was considered for significance. Pharmacogenetic testing helped to improve the clinical outcome as measured by the Clinical Global Impressions (CGI) Scale in virtually all children (95%; 19 out of 20 children). The CGI improvement (CGI-I) was 2 (0.79) (range 1-4), 2.1 (0.56) (range 1-3), and 1.9 (0.99) (range 1-4) in foster and non-foster care children, respectively. Pharmacogenetic testing also helped to reduce the number of children using polypharmacy (from 65 to 45%), the mean number of drugs per children (from 3.3 to 2.4 drugs, p = 0.017), and self-reported relevant side effects (p = 0.006). Pharmacogenetic testing helped to improve the clinical outcome, and to reduce polypharmacy and the number of drugs used in children and adolescents with severe mental disorders. More evidence using robust (i.e., clinical trials) independent studies is required to properly determine the clinical utility and cost-effectiveness of pharmacogenetic testing tools in children and adolescents with mental disorders.
这是一项回顾性队列研究，纳入 20 名儿童和青少年，旨在评估药物遗传学决策支持工具的临床实用性。20 名儿童和青少年于 2014 年 6 月至 2017 年 5 月接受药物遗传学检测。所有儿童和青少年均在西班牙马德里 Puerta de Hierro 大学医院-Majadahonda 进行评估。我们报告了达到临床改善、减轻副作用和减少药物数量的患者比例。采用 Shapiro-Wilk 检验评估数据正态性，采用配对样本 Wilcoxon 检验分析药物遗传学检测前后的变化。双侧 p 值阈值为 0.05 认为具有统计学意义。药物遗传学检测有助于改善临床结局，几乎所有儿童（95%；20 名儿童中的 19 名）均通过临床总体印象量表（Clinical Global Impressions Scale，CGI）进行评估。CGI 改善（CGI-I）分别为 2（0.79）（范围 1-4）、2.1（0.56）（范围 1-3）和 1.9（0.99）（范围 1-4），分别在寄养和非寄养儿童中。药物遗传学检测还有助于减少使用多种药物的儿童比例（从 65%降至 45%）、每名儿童的平均用药数量（从 3.3 降至 2.4 种药物，p=0.017）和报告的相关副作用（p=0.006）。药物遗传学检测有助于改善严重精神障碍儿童和青少年的临床结局，减少药物使用的种类和数量。需要使用更稳健（即临床试验）的独立研究提供更多证据，以正确确定药物遗传学检测工具在儿童和青少年精神障碍中的临床实用性和成本效益。
