Pharmacogenomic Test Improves MDD Response and Remission Outcomes
Clinician use of a specific weighted multigene pharmacogenomic (PGx) test significantly improved outcomes in adult patients with major depressive disorder (MDD) with at least 1 treatment failure, according to meta-analysis results published in the Journal of Clinical Psychopharmacology.
Although several meta-analyses have previously suggested benefit with PGx testing, the investigations differed in the PGx tests used and trial designs employed. The current meta-analysis focused on prospective controlled studies that specifically used the GeneSight Psychotropic test from Myriad Genetics.
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The meta-analysis included 3532 adults with MDD and 1 or more treatment failures from a total 6 studies (2 randomized controlled trials and 2 open-label trials) that compared PGx-guided care with treatment as usual. The studies evaluated response and remission outcomes at week 8 or week 10. A 50% or greater improvement in scores on the Hamilton Depression Rating Scale (HAM-D17) or the Patient Health Questionnaire (PHQ-9) was considered response, and a HAM-D17 score of 7 or less or a PHQ-9 score of 5 or less was considered remission.
According to the results, patients whose care was guided by the PGx test were 30% more likely to achieve response compared with treatment as usual, for a relative risk ratio of 1.30. Moreover, they were 41% more likely to achieve remission than patients who received treatment as usual, for a relative risk ratio of 1.41.
Researchers detected no heterogeneity across studies.
“The enhanced response and remission achieved through application of the weighted multigene PGx test provides the strongest existing tool for applying a personalized approach to selecting an antidepressant medication for the treatment of nonpsychotic MDD,” wrote corresponding author Holly L. Johnson, PhD, of Myriad Genetics, Mason, Ohio, and study coauthors.
The effect sizes of the PGx test are larger than those for clinical factors previously studied for antidepressant selection, the authors noted, while no other biological measures have reproducibly demonstrated a better ability to guide antidepressant choices for remission.
“When attempting to personalize medication for their patients, clinicians may consider utilizing weighted multigene PGx testing to inform prescribing for depression treatment,” researchers concluded
In a news release, Myriad Genetics announced plans to submit data from the meta-analysis to payers to increase patient access to the GeneSight test.
