Pharmacogenomic Testing and Depressive Symptom Remission: A Systematic Review and Meta‐Analysis of Prospective, Controlled Clinical Trials

Lisa C. Brown; Joseph D. Stanton; Kanika Bharthi; Abdullah Al Maruf; Daniel J. Müller; Chad A. Bousman

doi:10.1002/cpt.2748

journal article Open Access Oct 11, 2022

Pharmacogenomic Testing and Depressive Symptom Remission: A Systematic Review and Meta‐Analysis of Prospective, Controlled Clinical Trials

Lisa C. Brown

Joseph D. Stanton Kanika Bharthi Abdullah Al Maruf

Daniel J. Müller Chad A. Bousman

Clinical Pharmacology & Therapeutics Vol. 112 No. 6 pp. 1303-1317 · Wiley

View at Publisher Save 10.1002/cpt.2748

Abstract

Pharmacogenomic (PGx) testing has emerged as a compelling strategy that clinicians can use to inform antidepressant medication selection and dosing, but the clinical efficacy of this strategy has been questioned. We systematically reviewed and meta‐analyzed clinical trials for an association between the use of PGx‐guided antidepressant therapy and depressive symptom remission in patients with major depressive disorder (MDD). We included prospective, controlled clinical trials published in English up to July 12, 2022. Data extraction and synthesis adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Each trial was assessed for risk of bias and a random‐effects model was used to estimate pooled risk ratios. Thirteen trials comprising 4,767 patients were analyzed, including 10 randomized controlled trials, and three open label trials. Across all included trials, those that received PGx‐guided antidepressant therapy (n = 2,395) were 1.41 (95% confidence interval (CI) = 1.15–1.74, P = 0.001) more likely to achieve remission compared with those that received unguided antidepressant therapy (n = 2,372). Pooled risk ratios for randomized controlled trials and open label trials were 1.46 (95% CI: 1.13–1.88) and 1.26 (95% CI = 0.84–1.88), respectively. These results suggest that PGx‐guided antidepressant therapy is associated with a modest but significant increase in depressive symptom remission in adults with MDD. Efforts to address the heterogeneity in PGx test composition (i.e., genes and alleles tested) and accompanying prescribing recommendations across trials will likely reduce the uncertainty about the efficacy of PGx‐guided antidepressant therapy in the literature.

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Details

Published: Oct 11, 2022
Vol/Issue: 112(6)
Pages: 1303-1317
License: View

Authors

L

Lisa C. Brown

Great Scott! Consulting New York New York USA

J

Joseph D. Stanton

Tempus Labs Chicago Illinois USA

K

Kanika Bharthi

Department of Biological Sciences University of Calgary Calgary Alberta Canada

A

Abdullah Al Maruf

The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine University of Calgary Calgary Alberta Canada; College of Pharmacy, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada; Children's Hospital Research Institute of Manitoba Winnipeg Manitoba Canada

D

Daniel J. Müller

Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute Centre for Addiction and Mental Health Toronto Ontario Canada; Department of Psychiatry University of Toronto Toronto Ontario Canada; Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health University Hospital of Würzburg Würzburg Germany

C

Chad A. Bousman

The Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, Cumming School of Medicine University of Calgary Calgary Alberta Canada; Departments of Medical Genetics, Psychiatry, Physiology and Pharmacology, and Community Health Sciences University of Calgary Calgary Alberta Canada; Alberta Children's Hospital Research Institute University of Calgary Calgary Alberta Canada

Cite This Article

Lisa C. Brown, Joseph D. Stanton, Kanika Bharthi, et al. (2022). Pharmacogenomic Testing and Depressive Symptom Remission: A Systematic Review and Meta‐Analysis of Prospective, Controlled Clinical Trials. Clinical Pharmacology & Therapeutics, 112(6), 1303-1317. https://doi.org/10.1002/cpt.2748

Pharmacogenomic Testing and Depressive Symptom Remission: A Systematic Review and Meta‐Analysis of Prospective, Controlled Clinical Trials

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