Pharmacogenomics guided versus standard antidepressant treatment in a community pharmacy setting: A randomized controlled trial |
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| Authors: | John Papastergiou Lena C. Quilty Wilson Li Thulasi Thiruchselvam Esha Jain Peter Gove Leilany Mandlsohn Bart van den Bemt Nedzad Pojskic |
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| Affiliation: | 1. University of Toronto, Toronto Ontario, Canada ; 2. University of Waterloo, Kitchener Ontario, Canada ; 3. Shoppers Drug Mart, Toronto Ontario, Canada ; 4. Centre for Addiction and Mental Health, Toronto Ontario, Canada ; 5. Green Shield Canada, Toronto Ontario, Canada ; 6. Sint Maartenskliniek, Nijmegen The Netherlands ; 7. Radboud University Medical Center, Nijmegen The Netherlands |
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| Abstract: | The literature on pharmacogenomics as a tool to support antidepressant precision is burgeoning. Recently, a more active role has been argued for pharmacists in pharmacogenomic testing, with both pharmacists and family physicians perceiving pharmacist‐led testing as a valuable method by which to scale this innovation for depression treatment. In this prospective, single‐blind randomized controlled design, we evaluated the impact of pharmacogenomics guided versus standard antidepressant treatment of depression and anxiety, implemented in three large community pharmacies. Participants were 213 outpatients diagnosed with major depressive disorder and/or generalized anxiety disorder, randomized to receive pharmacogenomics guided (n = 105) or standard antidepressant treatment (n = 108); participants were blinded to the study. Patient reported outcomes of depression, anxiety, disability, and treatment satisfaction were assessed at months 0, 1, 3, and 6. Hypotheses were investigated using mixed effect models on the full data. All clinical outcomes improved significantly. The primary outcome (depression) and two secondary outcomes (generalized anxiety and disability) exhibited significant time by group interactions indicating that they improved for participants who received pharmacogenomics guided treatment more so than they did for participants who received standard treatment. Treatment satisfaction improved similarly for both groups. Results contribute to a growing body of work evaluating the impact of pharmacogenomics testing to inform antidepressant medication treatment for depression and anxiety, and provides important initial evidence for the role of pharmacists in care delivery. Pharmacogenomic testing may be a valuable tool to allow pharmacists to more effectively collaborate in facilitating clinical treatment decisions. ClinicalTrials.gov registration: ({"type":"clinical-trial","attrs":{"text":"NCT03591224","term_id":"NCT03591224"}}NCT03591224). Study Highlights - WHAT IS THE CURRENT KNOWLEDGE ON THE TOPIC?
Findings are mixed on whether pharmacogenomic testing as a tool to guide antidepressant treatment improves depression response, remission, and symptom severity. - WHAT QUESTION DID THIS STUDY ADDRESS?
We evaluated the impact of pharmacogenomics guided versus standard antidepressant treatment of depression and anxiety as they occur in the real‐world, implemented by pharmacists in three large community pharmacies. - WHAT DOES THIS STUDY ADD TO OUR KNOWLEDGE?
Results from this study provide initial evidence in support of a pharmacist‐led pharmacogenomic testing program in the treatment of mental health difficulties, as well as evidence for the role of pharmacists in care delivery. - HOW MIGHT THIS CHANGE CLINICAL PHARMACOLOGY OR TRANSLATIONAL SCIENCE?
In supporting the external validity of pharmacogenomic testing, this study has implications for how primary care clinicians may manage antidepressant medication use in their patients. In conjunction with measurement‐based care, pharmacogenomic testing may help pharmacists more confidently and effectively manage patients in a protocolized and evidence‐based manner. |
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