Clinical effectiveness of pharmacogenomic-guided antidepressant treatment in adult major depressive disorder: systematic review and exploratory platform-aware meta-analysis.

Combinatorial pharmacogenomic tests (multigene panels, e.g. GeneSight) guiding antidepressant selection and dosing.

Systematic review and exploratory platform-aware meta-analysis of randomised trials comparing combinatorial pharmacogenomic-guided antidepressant prescribing with treatment as usual in adult major depressive disorder. Eight RCTs were included. In the primary analysis restricted to the GeneSight panel (three trials), guided care increased response (RR 1.30; 95% CI 1.09-1.56). Pooled effects across other multigene panels were heterogeneous and imprecise, and the authors stress that the platform-aware structure should not be read as evidence of superiority of any commercial platform.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

The value lies in the method: refusing blind pooling of heterogeneous platforms and isolating the actual RCT evidence. The short-term GeneSight benefit remains modest and limited by the small number of trials, residual risk of bias and heterogeneity. Useful to temper the claims made for combinatorial tests without dismissing them — harmonising outcomes is the next step.

Analysis by Dr Thibaut Benquey