Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Yale School of Medicine, Yale University, New Haven, CT, USA.
Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
J Affect Disord. 2021 Mar 1;282:1272-1277. doi: 10.1016/j.jad.2021.01.034. Epub 2021 Jan 14.
Pharmacogenetic (PGx) testing is a potentially important, but understudied approach to precision medicine that could improve prescribing practices for antidepressants (ADs) in patients with Major Depressive Disorder (MDD). Thus, it is important to understand the scope of its potential impact and to identify patients who may benefit most from PGx-guided care.
Participants were treatment-seeking US veterans (N=1149) with MDD enrolled in the Precision Medicine in Mental Health Care study, a pragmatic multi-site, randomized, controlled trial that examines the utility of PGx testing in the context of pharmacotherapy for MDD. We report the prevalence of ADs with predicted moderate and clinically significant gene-drug interaction potential based on next-intended treatment. We also examined demographic and treatment history characteristics as predictors of the gene-drug interaction potential of participants' next-intended treatment.
Prevalence of the next-intended AD with moderate or clinically significant gene-drug interaction was 45.1% and19.3%. Previous treatment with an AD in the past two years was associated with a 1.59 increased likelihood of having a next-intended AD treatment with predicted clinically significant gene-drug interaction (95% CI: 1.08-2.35).
The gene-drug interaction potential of ADs is specific to the PGx test panel used in this study and may not generalize to other PGx test panels.
PGx testing could benefit one in five patients prescribed ADs with clinically significant gene-drug interaction potential. Patients with prior AD treatment are more likely to have an AD with significant gene-drug interaction potential as their next-intended treatment and therefore may benefit most from PGx testing.
药物遗传学（PGx）检测是精准医学中一种具有潜在重要性但研究不足的方法，它可以改善重度抑郁症（MDD）患者抗抑郁药（AD）的处方实践。因此，了解其潜在影响的范围并确定最有可能从 PGx 指导护理中获益的患者非常重要。
参与者是参加心理健康精准医疗研究的美国退伍军人（N=1149），他们正在寻求治疗，患有 MDD，这是一项实用的多地点、随机、对照试验，研究了 PGx 检测在 MDD 药物治疗背景下的效用。我们根据下一预期治疗报告了具有中度和临床显著基因-药物相互作用潜力的 AD 的患病率。我们还检查了人口统计学和治疗史特征作为参与者下一预期治疗的基因-药物相互作用潜力的预测指标。
具有中度或临床显著基因-药物相互作用的下一预期 AD 的患病率为 45.1%和 19.3%。过去两年中使用过 AD 的患者，下一预期 AD 治疗具有预测临床显著基因-药物相互作用的可能性增加了 1.59 倍（95%CI：1.08-2.35）。
AD 的基因-药物相互作用潜力是特定于本研究中使用的 PGx 测试面板的，可能不适用于其他 PGx 测试面板。
PGx 检测可能使五分之一接受具有临床显著基因-药物相互作用潜力的 AD 治疗的患者受益。有既往 AD 治疗史的患者更有可能将具有显著基因-药物相互作用潜力的 AD 作为其下一预期治疗，因此最有可能从 PGx 检测中受益。
