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Pharmacogenetic testing for the guidance of psychiatric treatment: a multicenter retrospective analysis

Published online by Cambridge University Press:  21 April 2016

Jordi Espadaler Open the ORCID record for Jordi Espadaler [Opens in a new window] ,
Miquel Tuson ,
Jose Miguel Lopez-Ibor ,
Franciso Lopez-Ibor  and
Maria Ines Lopez-Ibor
Jordi Espadaler*
Affiliation:
Innovation Department, AB-Biotics SA, Barcelona, Spain
Miquel Tuson
Affiliation:
Innovation Department, AB-Biotics SA, Barcelona, Spain
Jose Miguel Lopez-Ibor
Affiliation:
Center Dr. Lopez-Ibor SA, Madrid, Spain
Franciso Lopez-Ibor
Affiliation:
Quibor SL, Madrid, Spain
Maria Ines Lopez-Ibor
Affiliation:
Department of Psychiatry, College of Medicine, Complutense University of Madrid, Madrid, Spain Institute of Neurological Investigations Lopez-Ibor, Madrid, Spain
*
*Address for correspondence: Jordi Espadaler, PhD, AB-BIOTICS S.A., Eureka Building, Autonomous University of Barcelona Bellaterra, Barcelona 08193, Spain. (Email: [email protected])
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Abstract

Objective

We investigated the association between clinical outcome and the recommendations of a pharmacogenetic test (Neuropharmagen) in patients with a variety of psychiatric conditions whose previous treatment regimen had failed.

Methods

This retrospective, naturalistic, multicenter study included adult psychiatric patients (depression, psychosis, anxiety, bipolar, etc.) who had been seen at 3 private clinics. All patients had received pharmacogenetic testing (Neuropharmagen) and were classified depending on whether or not their post-test treatment regimen followed the test recommendations. Clinical severity was assessed with the Clinical Global Impression of Severity (CGI-S) at baseline (pre-test) and 3-month follow-up, and adverse events were recorded.

Results

182 patients were available for analysis. After multivariate adjustment, patients whose treatment followed the test recommendations had odds of improvement about 4 times greater than patients whose treatment did not follow the recommendations (adjusted OR=3.86, 95%CI 1.36–10.95; p=0.011). Importantly, psychiatric diagnosis did not significantly affect the odds of improvement. Also, in the subpopulation with baseline CGI-S score >3 (N=170), the rate of stabilization at follow-up (defined as CGI-S≤3) was significantly higher in patients whose treatment followed the pharmacogenetic recommendations (p=0.033). There was no apparent difference in the incidence of adverse events (6 patients in each group).

Conclusions

Non–drug naïve patients whose treatment followed the recommendations of pharmacogenetic testing were more likely to improve their condition than patients whose treatment did not. These results are consistent with previous clinical research on depressed patients, and this study also suggests that this benefit can be extended to psychiatric conditions other than depression.

Keywords

anxietybipolar disorderdepressiongenomicspersonalized medicinepharmacogeneticspsychiatric treatmentpsychotic disorder
Type
Original Research
Information
CNS Spectrums , Volume 22 , Issue 4 , August 2017 , pp. 315 - 324
Copyright
© Cambridge University Press 2016 

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Footnotes

We would like to thank Ariana Salavert, PhD (AB-Biotics SA), for help in preparing the study protocol; ADKNOMA Health Research SL (Barcelona, Spain), for providing contract research organization services; and Michael Hanna, PhD (Mercury Medical Research & Writing), for providing medical writing services.

References

1. Vos, T, Flaxman, AD, Naghavi, M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859): 2163–2196.Google Scholar
2. McClintock, SM, Husain, MM, Wisniewski, SR, et al. Residual symptoms in depressed outpatients who respond by 50% but do not remit to antidepressant medication. J Clin Psychopharmacol. 2011; 31(2): 180–186.Google Scholar
3. Rush, AJ, Trivedi, MH, Wisniewski, SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006; 163(11): 1905–1917.Google Scholar
4. Warden, D, Rush, AJ, Trivedi, MH, Fava, M, Wisniewski, SR. The STAR*D Project results: a comprehensive review of findings. Curr Psychiatry Rep. 2007; 9(6): 449–459.Google Scholar
5. Dunner, DL, Rush, AJ, Russell, JM, et al. Prospective, long-term, multicenter study of the naturalistic outcomes of patients with treatment-resistant depression. J Clin Psychiatry. 2006; 67(5): 688–695.CrossRefGoogle ScholarPubMed
6. Sienaert, P, Lambrichts, L, Dols, A, De Fruyt, J. Evidence-based treatment strategies for treatment-resistant bipolar depression: a systematic review. Bipolar Disord. 2013; 15(1): 61–69.Google Scholar
7. Ravindran, LN, Stein, MB. The pharmacologic treatment of anxiety disorders: a review of progress. J Clin Psychiatry. 2010; 71(7): 839–854.Google Scholar
8. Lieberman, JA, Stroup, TS, McEvoy, JP, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005; 353(12): 1209–1223.Google Scholar
9. Sinclair, D, Adams, CE. Treatment resistant schizophrenia: a comprehensive survey of randomised controlled trials. BMC Psychatry. 2014; 14: 253.Google Scholar
10. Bijl, MJ, Visser, LE, Hofman, A, et al. Influence of the CYP2D6*4 polymorphism on dose, switching and discontinuation of antidepressants. Br J Clin Pharmacol. 2008; 65(4): 558–564.Google Scholar
11. Kato, M, Serretti, A. Review and meta-analysis of antidepressant pharmacogenetic findings in major depressive disorder. Mol Psychiatry. 2010; 15(5): 473–500.Google Scholar
12. Risselada, AJ, Vehof, J, Bruggeman, R, et al. Association between HTR2C gene polymorphisms and the metabolic syndrome in patients using antipsychotics: a replication study. Pharmacogenomics J. 2012; 12(1): 62–67.Google Scholar
13. Drozda, K, Müller, DJ, Bishop, JR. Pharmacogenomic testing for neuropsychiatric drugs: current status of drug labeling, guidelines for using genetic information, and test options. Pharmacotherapy. 2014; 34(2): 166–184.Google Scholar
14. Hicks, JK, Swen, JJ, Thorn, CF, et al. Clinical Pharmacogenetics Implementation Consortium guideline for CYP2D6 and CYP2C19 genotypes and dosing of tricyclic antidepressants. Clin Pharmacol Ther. 2013; 93(5): 402–408.Google Scholar
15. Swen, JJ, Nijenhuis, M, de Boer, A, et al. Pharmacogenetics: from bench to byte—an update of guidelines. Clin Pharmacol Ther. 2011; 89(5): 662–673.Google Scholar
16. Uhr, M, Tontsch, A, Namendorf, C, et al. Polymorphisms in the drug transporter gene ABCB1 predict antidepressant treatment response in depression. Neuron. 2008; 57(2): 203–209.Google Scholar
17. Vega, M, Sánchez, P, García, M, et al. Análisis Farmacogenético en psiquiatría, estudio descriptivo de una experiencia clínica con 21 pacientes. Psiquiatria.com. 2012; 16: 5.Google Scholar
18. Chapman, SCE, Horne, R. Medication nonadherence and psychiatry. Curr Opin Psychiatry. 2013; 26(5): 446–452.CrossRefGoogle ScholarPubMed
19. Charland, SL, Agatep, BC, Herrera, V, et al. Providing patients with pharmacogenetic test results affects adherence to statin therapy: results of the Additional KIF6 Risk Offers Better Adherence to Statins (AKROBATS) trial. Pharmacogenomics J. 2014; 14(3): 272–280.Google Scholar
20. Winner, J, Carhart, JM, Altar, CA, Allen, JD, Dechairo, BM. A prospective, randomized, double-blind study assessing the clinical impact of integrated pharmacogenomic testing for major depressive disorder. Discov Med. 2013; 16(89): 219–227.Google Scholar
21. Hall-Flavin, DK, Winner, JG, Allen, JD, et al. Utility of integrated pharmacogenomic testing to support the treatment of major depressive disorder in a psychiatric outpatient setting. Pharmacogenet Genomics. 2013; 23(10): 535–548.Google Scholar
22. Winner, J, Allen, JD, Anthony Altar, C, Spahic-Mihajlovic, A. Psychiatric pharmacogenomics predicts health resource utilization of outpatients with anxiety and depression. Transl Psychiatry. 2013; 3: e242.Google Scholar
23. Herbild, L, Andersen, SE, Werge, T, Rasmussen, HB, Jürgens, G. Does pharmacogenetic testing for CYP450 2D6 and 2C19 among patients with diagnoses within the schizophrenic spectrum reduce treatment costs? Basic Clin Pharmacol Toxicol. 2013; 113(4): 266–272.Google Scholar
24. Breitenstein, B, Scheuer, S, Pfister, H, et al. The clinical application of ABCB1 genotyping in antidepressant treatment: a pilot study. CNS Spectr. 2014; 19(2): 165–175.Google Scholar
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