Pharmacogenomic (PGx) testing has emerged as a compelling strategy that clinicians can use to inform antidepressant medication selection and dosing, but the clinical efficacy of this strategy has been questioned. We systematically reviewed and meta-analyzed clinical trials for an association between the use of PGx-guided antidepressant therapy and depressive symptom remission in patients with major depressive disorder (MDD). We included prospective, controlled clinical trials published in English up to July 12, 2022. Data extraction and synthesis adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Each trial was assessed for risk of bias and a random-effects model was used to estimate pooled risk ratios. Thirteen trials comprising 4,767 patients were analyzed, including 10 randomized controlled trials, and three open label trials. Across all included trials, those that received PGx-guided antidepressant therapy (n = 2,395) were 1.41 (95% confidence interval (CI) = 1.15–1.74, P = 0.001) more likely to achieve remission compared with those that received unguided antidepressant therapy (n = 2,372). Pooled risk ratios for randomized controlled trials and open label trials were 1.46 (95% CI: 1.13–1.88) and 1.26 (95% CI = 0.84–1.88), respectively. These results suggest that PGx-guided antidepressant therapy is associated with a modest but significant increase in depressive symptom remission in adults with MDD. Efforts to address the heterogeneity in PGx test composition (i.e., genes and alleles tested) and accompanying prescribing recommendations across trials will likely reduce the uncertainty about the efficacy of PGx-guided antidepressant therapy in the literature.

中文翻译：

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药物基因组学测试和抑郁症状缓解：前瞻性对照临床试验的系统评价和荟萃分析

药物基因组学 (PGx) 测试已成为一种引人注目的策略，临床医生可以使用它来告知抗抑郁药物的选择和剂量，但该策略的临床疗效受到质疑。我们系统地回顾和荟萃分析了临床试验，以了解重度抑郁症 (MDD) 患者使用 PGx 指导的抗抑郁治疗与抑郁症状缓解之间的关联。我们纳入了截至 2022 年 7 月 12 日以英文发表的前瞻性对照临床试验。数据提取和合成遵循 2020 年系统评价和元分析首选报告项目指南。每个试验都评估了偏倚风险，并使用随机效应模型来估计合并风险比。分析了包含 4,767 名患者的 13 项试验，其中包括 10 项随机对照试验，和三个开放标签试验。在所有纳入的试验中，接受 PGx 指导的抗抑郁治疗的试验（n = 2,395) 与接受无指导抗抑郁治疗的患者 ( n  = 2,372) 相比，达到缓解的可能性 高 1.41（95% 置信区间 (CI) = 1.15–1.74，P = 0.001）。随机对照试验和开放标签试验的合并风险比分别为 1.46 (95% CI: 1.13–1.88) 和 1.26 (95% CI = 0.84–1.88)。这些结果表明，PGx 指导的抗抑郁治疗与成年 MDD 患者抑郁症状缓解的适度但显着增加相关。努力解决 PGx 测试组成（即测试的基因和等位基因）的异质性以及跨试验的伴随处方建议可能会减少文献中关于 PGx 指导的抗抑郁治疗疗效的不确定性。