Combinatorial Pharmacogenomic Testing Improves Outcomes for Older Adults With Depression
| Autor: | Charles R. Conway, Boadie W. Dunlop, Matthew Macaluso, Paul Traxler, Anthony J. Rothschild, Michael E. Thase, Charles DeBattista, Sagar V. Parikh, James Li, Jennifer Logan, Lisa M. Brown, Sara L. Weisenbach, Olusola Ajilore, Richard C. Shelton, Bryan Dechairo, Brent P. Forester, Ipsit V. Vahia, John F. Greden |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Pharmacogenomic Testing law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine Outcome Assessment Health Care Post-hoc analysis medicine Humans Treatment Failure Psychiatry Selection (genetic algorithm) Depression (differential diagnoses) Aged Psychiatric Status Rating Scales Response rate (survey) Depressive Disorder Major 030214 geriatrics Drug Substitution business.industry Patient Selection Pharmacogenomic Test Late life depression medicine.disease Comorbidity Antidepressive Agents humanities Antidepressant medication Psychiatry and Mental health Influential Publication Major depressive disorder Female Geriatrics and Gerontology business |
| Zdroj: | Focus (Am Psychiatr Publ) |
| ISSN: | 1064-7481 |
| DOI: | 10.1016/j.jagp.2020.05.005 |
| Popis: | 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 Conclusions Combinatorial pharmacogenomic test-informed medication selection improved outcomes over TAU among older adults with depression. |
| Databáze: | OpenAIRE |
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