GeneSight pharmacogenomic test linked to improved outcomes among patients with depression
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Use of a combinatorial pharmacogenomic test appeared associated with improved outcomes among patients with major depressive disorder, according to data presented at the American Society of Clinical Psychopharmacology Annual Meeting.
“Unfortunately, only 50% of patients experience a clinically meaningful response to their first antidepressant trial, with an even smaller proportion of patients reaching full remission, arguably the most important goal of treatment,” Rachel Daut, PhD, of Myriad Neuroscience, told Healio Psychiatry. “Pharmacogenetics is one of several factors that can impact how an individual responds to certain medications. GeneSight Psychotropic [Myriad Genetics] is a pharmacogenomic test that analyzes clinically important genetic variations in a patient’s DNA, and the results of the test can inform the clinician about genes that may impact how the patient metabolizes or responds to certain medications.”
According to Daut and colleagues, evidence is mixed regarding the utility of pharmacogenomic testing. Because meta-analyses provide abundant evidence and can aid evaluation of the overall testing approach for clinical use, such analyses should be performed for each pharmacogenomic test, they noted.
In the current meta-analysis, the researchers evaluated GeneSight Psychotropic’s impact on treatment outcomes among patients with MDD who had one or more prior medication failures. They identified two-arm, prospective studies that evaluated the clinical utility of this test and included patients aged 18 years or older diagnosed with MDD who had one or more prior medication failures. Daut and colleagues analyzed 1,556 patients from two open-label studies and two randomized controlled trials. Studies used the 17-item Hamilton Depression Rating Scale to assess symptom improvement, response and remission. The researchers used a random effects model to calculate the pooled mean effect of symptom improvement and pooled relative risk ratio of response and remission, and they performed sub-analyses according to study type.
Results showed significant improvements in outcomes for patients with MDD whose care was guided by GeneSight Psychotropic test results compared with unguided care. Daut and colleagues noted significant heterogeneity in effect size across studies, but it was moderate for symptom improvement and was not significant for response and remission. Symptoms and response improved significantly in the GeneSight Psychotropic guided-care group vs. the unguided care group when the researchers assessed the open-label studies separately. Moreover, all three evaluated outcomes improved significantly in the guided-care group vs. the unguided care group when the researchers restricted the analysis to randomized controlled trials.
“These findings are in alignment with two other recent meta-analyses that found a variety of pharmacogenetic decision support tools were significantly associated with achieving remission in MDD treatment compared with treatment as usual,” Daut told Healio Psychiatry. “However, the tests evaluated in these meta-analyses vary considerably in terms of genes included on the panel, genotype-to-phenotype conversion and algorithm. The present study provides robust evidence supporting the clinical utility of GeneSight Psychotropic.”