The degree of agreement between four commercial pharmacogenetic-based decision support tools (DSTs) was examined in five outpatients with major depressive disorder and at least two previous antidepressant failures. Comparisons were made across seven pharmacokinetic (CYP1A2, CYP2B6, CYP2C19, CYP2C9, CYP2D6, CYP3A4, and UGT2B15) and seven pharmacodynamic (BDNF, COMT, HLA-A, HTR2A, HTR2C, OPRM1, and SLC6A4) genes that were included on ≥2 of the four DST testing panels. Among these overlapping genes, genotype (33–100%) and predicted phenotype (20–100%) agreement varied substantially. Medication recommendation agreement was the greatest for mood stabilizers (84%), followed by antidepressants (56%), anxiolytics/hypnotics (56%), and antipsychotics (55%). Approximately one-quarter (26%) of all medication recommendations were jointly flagged by two or more DSTs as “actionable” but 19% of these recommendations provided conflicting advice (e.g., dosing) for the same medication.
The level of disagreement in medication recommendations across the pharmacogenetic DSTs indicates that these tests cannot be assumed to be equivalent or interchangeable. Additional efforts to standardize genetic-based phenotyping and to develop medication guidelines are warranted.
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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. AB Biotics, Assurex Health, Baycrest Biotechnology, and Genomind donated their testing kits, as well as their standard report generation and interpretation services for the purposes of this study. These donations amounted to a total of five tests per company. These companies had no role in the design of the study or the analysis of the study results. CAB was supported by a National Health and Medical Research Council of Australia (NHMRC) Career Development Fellowship (ID: 1127700).
Conflict of interest
CAB has active research collaborations with two pharmacogenetic testing companies (Baycrest Biotechnology and MyDNA), but has received no compensation from these collaborations. BWD has received research support from Acadia, Assurex Health, Inc., Axsome, Janssen, NIMH, Otsuka, Pfizer, and Takeda, and serves as a consultant to Assurex Health, Inc.
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Bousman, C.A., Dunlop, B.W. Genotype, phenotype, and medication recommendation agreement among commercial pharmacogenetic-based decision support tools. Pharmacogenomics J 18, 613–622 (2018). https://doi.org/10.1038/s41397-018-0027-3
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