The Clinical Utility of Combinatorial Pharmacogenomic Testing for Patients with Depression: A Meta-Analysis

Background: Pharmacogenomic (PGx) testing is a potential tool to inform clinicians’ treatment decisions for patients with Major Depressive Disorder (MDD). However, there is mixed evidence available for the utility of PGx testing depending on the test used and population studied. Given the differences between tests, evaluation of PGx testing as a class may not reflect the utility of an individual test. Here, we performed a meta-analysis of prospective, two-arm studies examining the utility of using GeneSight Psychotropic to inform treatment decisions for patients with MDD with at least one prior medication failure.

Methods: A systematic search was performed to identify prospective, two-arm studies evaluating the clinical utility of GeneSight for MDD patients ≥18 years of age with at least one prior medication failure. All included studies assessed symptom improvement, response, and remission using the 17-item Hamilton Depression Rating Scale (HAM-D17). The pooled mean effect of symptom improvement and pooled relative risk ratio (RR) of response and remission were calculated using a random effect model.

Results: Overall, 1,556 patients were included from four studies. Outcomes were significantly improved for patients whose care was guided by GeneSight results compared to unguided-care (symptom improvement ∆=10.08%, 95% CI=1.67-18.50, p=0.019; response RR=1.40, 95% CI=1.17-1.67, p < 0.001; remission RR=1.49, 95% CI=1.17-1.89, p=0.001). Further sub-analysis by study type also depicted improved outcomes.

Discussion: GeneSight-informed care improved outcomes among patients with MDD who had at least one prior medication failure. Additional research evaluating the value of GeneSight in other psychiatric diseases are warranted.