Clinical Utilization of Pharmacogenomic Testing in an integrated Behavioral Health Setting

Abstract

Specific Aims: To explore whether pharmacogenomic (PGx) testing would lead to an overall reduction in number of medications and increased clinical efficacy of antidepressant therapy. Method: In this retrospective review, we reviewed the charts of 100 patients in a behavioral health clinic who have been diagnosed with depression and have received a neuro PGx panel to observe and assess the clinical effectiveness of implementing PGx tests. Based on the inclusion criteria 87 patients were qualified and 28 patients were eligible for analysis of pre-PGx and post-PGx Patient Health Questionnaire (PHQ-9) scores. Wilcoxon singed-rank test and paired t-test were used for comparing the PHQ-9 scores, number of medications and PGx recommendations. Main Results: There was a significant difference when comparing PHQ-9 scores pre- and post-PGx testing (W=289, CV=116, P-value 0.001, CI 95%; SD 13.7, Mean 6.2 for pre-PGX; SD 5.9, Mean 8.9 for post-PGx). However, there was no significant difference between the number of medication used pre- and post-PGx for patients that carried variants, considering both Wilcoxon singed-rank test and paired t-test (|W|=286 CV>300, P-value 0.212; T-test P-value 0.211, alpha 0.05). The number of patients advised to use their medications as directed did not change significantly Pre- and post-PGx (nprior=151, npost=163, P-value 0.393, alpha 0.05). The number of patients taking “Use with Caution” medications based on pharmacogenomic results decreased significantly after PGx testing (nprior=70, npost=49, P-value 0.012, alpha 0.05). Conclusion: This study shows that pharmacogenomics testing can significantly affect the PHQ-9 scores and therefore increase the clinical efficacy of antidepressant therapy.