Department of Psychiatry, Chonnam National University Medical School, Gwangju 61469, Korea.
Department of Laboratory Medicine, Korea University Anam Hospital, Seoul 02841, Korea.
Int J Mol Sci. 2020 Jul 10;21(14):4884. doi: 10.3390/ijms21144884.
Planning subsequent treatment strategies based on early responses rather than waiting for delayed antidepressant action can be helpful. We identified genetic markers for later non-remission in patients exhibiting poor early improvement using whole-exome sequencing data of depressive patients treated in a naturalistic manner. Among 1000 patients, early improvement at 2 weeks (reduction in Hamilton Depression Rating Scale [HAM-D] score ≥ 20%) and remission at 12 weeks (HAM-D score ≤ 7) were evaluated. Gene- and variant-level analyses were conducted to compare patients who did not exhibit early improvement and did not eventually achieve remission ( = 126) with those who exhibited early improvement and achieved remission ( = 385). Genes predicting final non-remission in patients who exhibited poor early improvement (, , and in males; , and in females; in the total population) were determined. Among the significant genes, variants in the (rs1800014), (rs6267), (rs200565609), and genes (rs3213633) were identified. However, interpretations should be made cautiously, as complex pharmacotherapy involves various genes and pathways. Early detection of poor early improvement and final non-remission based on genetic risk would be helpful for decision-making in a clinical setting.
基于早期反应而不是等待抗抑郁药的延迟作用来规划后续治疗策略可能会有所帮助。我们使用接受自然治疗的抑郁患者的外显子组测序数据，确定了在早期改善较差的患者中以后不能缓解的遗传标志物。在 1000 名患者中，评估了 2 周时的早期改善（汉密尔顿抑郁量表[HAM-D]评分降低≥20%）和 12 周时的缓解（HAM-D 评分≤7）。进行了基因和变异水平分析，以比较未表现出早期改善且最终未缓解的患者（=126）和表现出早期改善且缓解的患者（=385）。确定了在早期改善较差的患者中最终未缓解的预测基因（男性中的 、 、 和 ；女性中的 、 和 ；总人群中的 ）。在显著基因中，确定了 基因（rs1800014）、 基因（rs6267）、 基因（rs200565609）和 基因（rs3213633）中的变异。然而，由于复杂的药物治疗涉及多种基因和途径，因此应谨慎解释。基于遗传风险对早期检测到的早期改善不良和最终无法缓解将有助于临床决策。
