Pharmacogenetic-Guided Treatment of Depression: Real-World Clinical Applications, Challenges, and Perspectives.
Journal
Clinical pharmacology and therapeutics
ISSN: 1532-6535
Titre abrégé: Clin Pharmacol Ther
Pays: United States
ID NLM: 0372741
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
received:
28
03
2021
accepted:
20
05
2021
pubmed:
29
5
2021
medline:
15
9
2021
entrez:
28
5
2021
Statut:
ppublish
Résumé
Depression is a leading cause of disability worldwide and, despite the availability of numerous antidepressants, the lack of standardized criteria to apply personalized prescription is still a major issue. Pharmacogenetic (PGx) markers in cytochrome P450 (CYP450) genes are already usable to guide antidepressant choice/titration according to clinical guidelines; they are an important step toward personalized psychiatry as they can reduce the time to identify an effective and tolerated treatment. Clinical application is still limited due to the financial and organizational challenges, but the number of services providing genotyping of pharmacogenes is increasing, with encouraging projections of cost-effectiveness. Critical aspects that emerged from the available studies are the importance of integration of genotyping results in electronic medical records, standardization, and regular updates of decision support systems, training and collaboration of different professionals, need of longer follow-ups to estimate cost-effectiveness, and importance of avoiding inequalities in access to genotyping. Diversities exist among the groups of patients to whom genotyping is offered (pre-emptive or reactive testing) and the type of clinical services (e.g., hospitals and primary care), currently without a consensus on which is the best approach. Future studies should aim to clarify these issues, as well as consider and compare PGx applications among different countries and healthcare systems. Finally, the extension of genotyping outside pharmacokinetic genes should be considered as a key step to improve the clinical impact of PGx, as this could significantly increase the variance explained in treatment outcomes.
Substances chimiques
Cytochrome P-450 Enzyme System
9035-51-2
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
573-581Informations de copyright
© 2021 The Authors. Clinical Pharmacology & Therapeutics © 2021 American Society for Clinical Pharmacology and Therapeutics.
Références
James, S.L. et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392, 1789-1858 (2018).
Kessler, R.C. et al. Using patient self-reports to study heterogeneity of treatment effects in major depressive disorder. Epidemiol. Psychiatr. Sci. 26, 22-36 (2017).
Wake, D.T., Ilbawi, N., Dunnenberger, H.M. & Hulick, P.J. Pharmacogenomics: prescribing precisely. Med. Clin. North Am. 103, 977-990 (2019).
Furukawa, T.A. et al. Optimal dose of selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine in major depression: a systematic review and dose-response meta-analysis. Lancet Psychiatry 6, 601-609 (2019).
Bousman, C.A. et al. Review and consensus on pharmacogenomic testing in psychiatry. Pharmacopsychiatry 54, 5-17 (2021).
Jukić, M.M., Haslemo, T., Molden, E. & Ingelman-Sundberg, M. Impact of CYP2C19 genotype on escitalopram exposure and therapeutic failure: a retrospective study based on 2,087 patients. Am. J. Psychiatry 175, 463-470 (2018).
Relling, M.V. et al. The clinical pharmacogenetics implementation consortium: 10 years later. Clin. Pharmacol. Ther. 107, 171-175 (2020).
Caudle, K.E. et al. Standardizing CYP2D6 genotype to phenotype translation: consensus recommendations from the Clinical Pharmacogenetics Implementation Consortium and Dutch Pharmacogenetics Working Group. Clin. Transl. Sci. 13, 116-124 (2020).
DPWG Pharmacogenetic Recommendations. <https://www.knmp.nl/patientenzorg/medicatiebewaking/farmacogenetica/pharmacogenetics-1/pharmacogenetics> (2020). Accessed April 19, 2021.
U-PGx Statement of support for the use of the European pharmacogenomic guidelines. <https://upgx.eu/guidelines/> (2018). Accessed April 19, 2021.
Quaranta, S., Dupouey, J., Colle, R. & Verstuyft, C. Pharmacogenetics of antidepressant drugs: State of the art and clinical implementation - recommendations from the French National Network of Pharmacogenetics. Therapies 72, 311-318 (2017).
University of Calgary Sequence2Script. <https://sequence2script.com/#/> (2021). Accessed April 20, 2021.
Bousman, C.A., Arandjelovic, K., Mancuso, S.G., Eyre, H.A. & Dunlop, B.W. Pharmacogenetic tests and depressive symptom remission: a meta-analysis of randomized controlled trials. Pharmacogenomics 20, 37-47 (2019).
Hiemke, C. et al. Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: update 2017. Pharmacopsychiatry 51, 9-62 (2018).
van Schaik, R.H.N., Müller, D.J., Serretti, A. & Ingelman-Sundberg, M. Pharmacogenetics in psychiatry: an update on clinical usability. Front. Pharmacol. 11, 575540 (2020).
Fabbri, C., Zohar, J. & Serretti, A. Pharmacogenetic tests to guide drug treatment in depression: comparison of the available testing kits and clinical trials. Prog. Neuropsychopharmacol. Biol. Psychiatry 86, 36-44 (2018).
Ramsey, L.B. et al. Implementation of pharmacogenetics at Cincinnati Children’s Hospital Medical Center: lessons learned over 14 years of personalizing medicine. Clin. Pharmacol. Ther. 105, 49-52 (2019).
Baldelli, S., Cheli, S., Montrasio, C., Cattaneo, D. & Clementi, E. Therapeutic drug monitoring and pharmacogenetics of antipsychotics and antidepressants in real life settings: A 5-year single centre experience. World J. Biol. Psychiatry. https://doi.org/10.1080/15622975.2020.1747112.19.
Bank, P.C.D., Swen, J.J. & Guchelaar, H.J. Estimated nationwide impact of implementing a preemptive pharmacogenetic panel approach to guide drug prescribing in primary care in the Netherlands. BMC Med. 17, 110 (2019).
Christensen, K.D. et al. Precision population medicine in primary care: the Sanford chip experience. Front. Genet. 12, 274 (2021).
International Society of Psychiatric Genetics Genetic Testing Statement <https://ispg.net/genetic-testing-statement/> (2019). Accessed April 26, 2021.
Maruf, A.A., Greenslade, A., Arnold, P.D. & Bousman, C. Antidepressant pharmacogenetics in children and young adults: a systematic review. J. Affect. Disord. 254, 98-108 (2019).
Westergaard, N., Søgaard Nielsen, R., Jørgensen, S. & Vermehren, C. Drug use in Denmark for drugs having pharmacogenomics (PGx) based dosing guidelines from CPIC or DPWG for CYP2D6 and CYP2C19 drug-gene pairs: perspectives for introducing PGx test to polypharmacy patients. J. Pers. Med. 10, 3 (2020).
Bush, W.S. et al. Genetic variation among 82 pharmacogenes: The PGRNseq data from the eMERGE network. Clin. Pharmacol. Ther. 100, 160-169 (2016).
Fabbri, C. & Serretti, A. How to utilize clinical and genetic information for personalized treatment of major depressive disorder: step by step strategic approach. Clin. Psychopharmacol. Neurosci. 18, 484-492 (2020).