Clinical Question

Is pharmacogenomic-guided antidepressant treatment beneficial in the management of major depressive disorder in adults?

Bottom Line

Pharmacogenomic testing for drug-gene interactions in adults with major depressive disorder resulted in reduced prescribing of medications with potential drug-gene interactions. However, no significant difference occurred in symptom remission rates in the gene-tested group compared with the usual care group at six months. (Level of Evidence = 1b)

Synopsis

The benefit of pharmacogenomic-guided selection of antidepressant therapy remains uncertain based on low-quality evidence. The investigators identified adults, 18 to 80 years of age, who met standard diagnostic criteria for major depressive disorder, had a history of at least one treatment episode, and were planning to switch treatments or start a new treatment episode. All patients (N = 1,944) underwent DNA collection and were randomly assigned (concealed allocation) to a group whose clinicians received the pharmaco-genomic test results within three business days or a group whose clinicians had to wait 24 weeks for results. Clinicians in the pharmacogenomic-guided group initiated treatment based on the results; the clinicians in the delayed-results group initiated treatment as usual. Individuals masked to treatment group assignment assessed the treatment results using standard scoring tools at four, eight, 12, 18, and 24 weeks. Complete follow-up occurred for 79% of patients at 24 months.

Using intention-to-treat analysis, the pharmacogenomic-guided group was significantly more likely to receive treatment with an antidepressant with no potential drug-gene interaction. Remission rates were significantly increased in the pharmacogenomic-guided group at eight and 12 weeks, but not at four, 18, or 24 weeks. The authors note that there were multiple comparisons made without statistical corrections, so results beyond the primary outcomes of drug choice and remission at 24 weeks are subject to interpretation.

Study design: Randomized controlled trial (single-blinded)

Funding source: Industry and foundation

Allocation: Concealed

Setting: Outpatient (any)

Reference: Oslin DW, Lynch KG, Shih MC, et al. Effect of pharmacogenomic testing for drug-gene interactions on medication selection and remission of symptoms in major depressive disorder: the PRIME care randomized clinical trial. JAMA. 2022;328(2):151-161.