Objective

Evaluate the clinical utility of combinatorial pharmacogenomic testing for informing medication selection among older adults who have experienced antidepressant medication failure for major depressive disorder (MDD).

Design

Post hoc analysis of data from a blinded, randomized controlled trial comparing two active treatment arms.

Setting

Psychiatry specialty and primary care clinics across 60 U.S. community and academic sites.

Participants

Adults age 65 years or older at baseline (n = 206), diagnosed with MDD and inadequate response to at least one medication on the combinatorial pharmacogenomic test report during the current depressive episode.

Intervention

Combinatorial pharmacogenomic testing to inform medication selection (guided-care), compared with treatment as usual (TAU).

Outcomes

Mean percent symptom improvement, response rate, and remission rateat week 8, measured using the 17-item Hamilton Depression Rating Scale; medication switching; and comorbidity moderator analysis.

Results

At week 8, symptom improvement was not significantly different for guided-care than for TAU (∆ = 8.1%, t = 1.64, df = 187; p = 0.102); however, guided-care showed significantly improved response (∆ = 13.6%, t = 2.16, df = 187; p = 0.032) and remission (∆ = 12.7%, t = 2.49, df = 189; p = 0.014) relative to TAU. By week 8, more than twice as many patients in guided-care than in TAU were on medications predicted to have no gene-drug interactions (χ² = 19.3, df = 2; p <0.001). Outcomes in the guided-care arm showed consistent improvement through the end of the open-design 24-week trial, indicating durability of the effect. Differences in outcomes between arms were not significantly impacted by comorbidities.

Conclusions

Combinatorial pharmacogenomic test-informed medication selection improved outcomes over TAU among older adults with depression.

中文翻译：

---

组合药物基因组学测试可改善患有抑郁症的老年人的结局。

目的

评估组合药物基因组学测试的临床效用，以告知患有严重抑郁障碍（MDD）的抗抑郁药物失败的老年人选择药物。

设计

事后分析来自盲法，随机对照试验的数据，比较了两个活跃的治疗组。

设置

美国60个社区和学术站点的精神病学专科和初级保健诊所。

参加者

基线时年龄为65岁或65岁以上的成年人（n = 206），被诊断为MDD，并且在本次抑郁发作期间对组合药物基因组学测试报告的至少一种药物反应不足。

介入

与常规治疗（TAU）相比，组合药物基因组学测试可指导药物选择（指导治疗）。

结果

使用17个项目汉密尔顿抑郁量表（Hamilton Depression Rating Scale）测量的第8周的平均症状改善百分比，缓解率和缓解率；药物转换；和合并症主持人分析。

结果

在第8周，指导治疗的症状改善与TAU无明显差异（∆ = 8.1％，t = 1.64，df = 187； p = 0.102）；然而，相对于TAU，指导治疗显示出显着改善的反应（∆ = 13.6％，t = 2.16，df = 187； p = 0.032）和缓解（∆ = 12.7％，t = 2.49，df = 189； p = 0.014） 。到第8周，因为许多患者在引导护理比TAU是药物上的两倍多预测具有无基因-药物相互作用（χ ²  = 19.3，DF = 2; P <0.001）。在开放式设计的24周试验结束时，导向治疗组的结果显示出持续的改善，表明了效果的持久性。合并症对两组间结局的差异影响不大。

结论

组合药物基因组学测试告知的药物选择在抑郁症老年人中比TAU改善了结局。