Optimization of individualized antidepressant drug administration strategies based on pharmacogenomics and its clinical validation study.

Interindividual variability in antidepressant response and tolerability is ascribed to the patient's pharmacogenomic profile, used here to set the dosing regimen; the abstract specifies neither the genes tested nor the phenotypes assigned.

Four hundred patients with depression were allocated either to individualized dosing regimens based on pharmacogenomic testing or to prescribing guided by clinical guidelines and physician experience. Outcomes included the Hamilton Depression Rating Scale (HAMD) score, incidence of adverse reactions, treatment discontinuation, readmission rate, medication adherence and quality of life (WHOQOL-BREF). The pharmacogenomics-guided group did significantly better for HAMD improvement (P < 0.05), overall clinical response rate (92% vs 74.5%), adverse reaction incidence (6% vs 13.5%) and discontinuation rate (6.53% vs 14.21%), all significant after FDR correction. Adherence and quality of life were also higher in the guided group. The authors conclude that pharmacogenomics-guided individualized prescribing is advantageous in depression.

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

The abstract names no gene, no phenotype and no decision rule, so the result is neither reproducible nor transferable to the clinic. Group allocation is described merely as a division, with no explicit randomization or blinding, which leaves room for allocation and measurement bias on self-reported outcomes such as adherence; the reported response gap (92% vs 74.5%) is far larger than in previous randomized trials of psychiatric pharmacogenomics. As it stands, this study does not change the role of pharmacogenomic testing before starting an antidepressant.

Analysis by Dr Thibaut Benquey