Del Tredici Andria L, Johnson Holly L, DeHart Brady, Gutin Alexander, Morin Pamela, Kasten Chelsea R, Becker Laura, Johansen Taber Katherine, Chawla Devika, Nierenberg Andrew A
Myriad Genetics, Salt Lake City, UT.
Optum, Eden Prairie, MN.
J Clin Psychopharmacol. 2025;45(4):320-328. doi: 10.1097/JCP.0000000000001999. Epub 2025 Apr 18.
Pharmacogenomic (PGx) testing can help improve response and remission rates for patients with major depressive disorder (MDD) and at least one treatment failure. To investigate real-world outcomes, we examined 1) significant gene-drug interactions (GDIs) and 2) healthcare resource utilization (HRU) in a large US insurance claims dataset.
Weighted multigene PGx testing results in adult patients with MDD were linked with deidentified US claims data. The PGx test report organized medications as congruent (no known or moderate GDI) or incongruent (significant GDI). Medication claims data before and after PGx testing was used to categorize patients as no change in congruency, incongruent-to-congruent, or congruent-to-incongruent. HRU (hospitalizations and emergency department visits) was compared in the 180 days before and after PGx testing.
A total of 20,933 patients met inclusion criteria; 16,965 of whom filled medication prescriptions before and after PGx testing. After PGx testing, the proportion of patients filling prescriptions with significant GDIs was reduced (26.1% pretesting vs 15.9% posttesting). All HRU was significantly reduced ( P < 0.001) after PGx testing except for nonpsychiatric hospitalizations ( P > 0.05). Psychiatric hospitalizations were significantly reduced after PGx testing in the incongruent-to-congruent and no change in congruency categories ( P < 0.001), but not in the congruent-to-incongruent category. Conversely, emergency department visits were significantly reduced after PGx testing in all congruency categories ( P < 0.005) and did not differ when compared across congruency categories.
After PGx testing, patients with MDD had decreased prescribing of medications with significant GDI and reduced HRU. PGx testing may have influenced these outcomes, but the retrospective study design limits clarity on its impact.
药物基因组学（PGx）检测有助于提高重度抑郁症（MDD）患者且至少有一次治疗失败经历者的反应率和缓解率。为了调查实际疗效，我们在美国一个大型保险理赔数据集里研究了1）显著的基因 - 药物相互作用（GDI）和2）医疗资源利用（HRU）情况。
成年MDD患者的加权多基因PGx检测结果与匿名化的美国理赔数据相关联。PGx检测报告将药物分为相符（无已知或中度GDI）或不相符（显著GDI）。PGx检测前后的药物理赔数据用于将患者分类为相符性无变化、从不相符到相符或从相符到不相符。比较PGx检测前后180天内的HRU（住院和急诊就诊情况）。
共有20933名患者符合纳入标准；其中16965名患者在PGx检测前后都开具了药物处方。PGx检测后，开具具有显著GDI药物处方的患者比例降低（检测前为26.1%，检测后为15.9%）。除非精神科住院外（P>0.05），PGx检测后所有HRU均显著降低（P<0.001）。在从不相符到相符和相符性无变化类别中，PGx检测后精神科住院显著减少（P<0.001），但在从相符到不相符类别中没有减少。相反，PGx检测后所有相符性类别中的急诊就诊次数均显著减少（P<0.005），且不同相符性类别之间无差异。
PGx检测后，MDD患者开具具有显著GDI药物的处方减少，HRU降低。PGx检测可能影响了这些结果，但回顾性研究设计限制了对其影响的明确性。
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