Pharmacogenomics guided versus standard antidepressant treatment in a community pharmacy setting: A randomized controlled trial

John Papastergiou, Lena C Quilty, Wilson Li, Thulasi Thiruchselvam, Esha Jain, Peter Gove, Leilany Mandlsohn, Bart van den Bemt, Nedzad Pojskic, John Papastergiou, Lena C Quilty, Wilson Li, Thulasi Thiruchselvam, Esha Jain, Peter Gove, Leilany Mandlsohn, Bart van den Bemt, Nedzad Pojskic

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: (NCT03591224).

Conflict of interest statement

Thulasi Thiruchselvam and Esha Jain received a stipend from Green Shield Canada to support their contribution to manuscript preparation. All other authors declared no competing interests for this work.

© 2021 The Authors. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of the American Society for Clinical Pharmacology and Therapeutics.

Figures

Figure 1
Figure 1
Clinical outcomes over time and study group. Note: PHQ‐9 = Patient Health Questionnaire 9; GAD‐7 = Generalized Anxiety Disorder 7; SDS = Sheehan Disability Scale; SATMED‐Q = Treatment Satisfaction with Medicines Questionnaire; Mth = Month; PGx Guided = Pharmacogenomics guided treatment. Panels illustrate the marginal means and standard errors of control and PGx Guided group at baseline, months 1, 3, and 6 across all clinical outcomes
Figure 2
Figure 2
Prescriber acceptance of pharmacist recommendations by payment type. Note: ODB = Ontario Drug Benefit program; TP = third party (i.e., insurance company). Figure illustrates the proportion of participants whose clinicians accepted pharmacist recommendations across remuneration type, or how medication costs were covered

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Source: PubMed

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