Abstract

OBJECTIVE: Evaluate the clinical utility of combinatorial pharmacogenomic testing for informing medication selection among older adults who have experienced antidepressant medication failure for major depressive disorder (MDD).DESIGN: Post hoc analysis of data from a blinded, randomized controlled trial comparing two active treatment arms.SETTING: Psychiatry specialty and primary care clinics across 60 U.S. community and academic sites.PARTICIPANTS: Adults age 65 years or older at baseline (n?=?206), diagnosed with MDD and inadequate response to at least one medication on the combinatorial pharmacogenomic test report during the current depressive episode.INTERVENTION: Combinatorial pharmacogenomic testing to inform medication selection (guided-care), compared with treatment as usual (TAU).OUTCOMES: Mean percent symptom improvement, response rate, and remission rateat week 8, measured using the 17-item Hamilton Depression Rating Scale; medication switching; and comorbidity moderator analysis.RESULTS: At week 8, symptom improvement was not significantly different for guided-care than for TAU (??=?8.1%, t?=?1.64, df?=?187; p?=?0.102); however, guided-care showed significantly improved response (??=?13.6%, t?=?2.16, df?=?187; p?=?0.032) and remission (??=?12.7%, t?=?2.49, df?=?189; p?=?0.014) relative to TAU. By week 8, more than twice as many patients in guided-care than in TAU were on medications predicted to have no gene-drug interactions (chi2?=?19.3, df?=?2; p <0.001). Outcomes in the guided-care arm showed consistent improvement through the end of the open-design 24-week trial, indicating durability of the effect. Differences in outcomes between arms were not significantly impacted by comorbidities.CONCLUSIONS: Combinatorial pharmacogenomic test-informed medication selection improved outcomes over TAU among older adults with depression.

View details for DOI 10.1016/j.jagp.2020.05.005

View details for PubMedID 32513518