Pharmacogenomics positively impacts polypharmacy-related toxicity and clinical outcomes in psychiatric patients

Panel-based pharmacogenomic-guided prescribing compared with usual care, across the two arms of the PREPARE psychiatric cohort

The authors analysed the impact of polypharmacy on drug toxicity, hospitalisation and quality of life, comparing the pharmacogenomics-guided arm with the control arm of the PREPARE psychiatric cohort. Patients in the guided arm had lower rates of both combined (41.95% vs 49.8%) and psychiatric polypharmacy (20.7% vs 26.1%). Polypharmacy patients in the guided arm also received fewer co-medications. The risk of hospitalisation in the presence of psychiatric polypharmacy was roughly halved in the guided arm (RR 0.49; 95% CI 0.36-0.67). The authors conclude that guided prescribing changes the choice and dosing of drugs rather than their number.

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

The most useful sentence here concerns the mechanism of the effect: the pharmacogenomic panel does not shorten the prescription, it changes its composition, shifting the debate from deprescribing towards the quality of molecular choice. A nearly halved hospitalisation risk is a strong signal in psychiatry, where polypharmacy is the rule rather than the exception. This remains a secondary analysis of PREPARE and subgroup sizes are not detailed in the abstract, which limits any judgement on robustness.

Analysis by Dr Thibaut Benquey