Overuse alert: Pharmacogenomic testing for selection of antidepressant provides minimal, if any, benefit (PRIME)

Reference

Oslin DW, Lynch KG, Shih MC, et al. Effect of pharmacogenomic testing for drug-gene interactions on medication selection and remission of symptoms in major depressive disorder. The PRIME care randomized clinical trial. JAMA 2022;328(2):151-161.

Synopsis

The benefit of pharmacogenomic-guided selection of antidepressant therapy remains uncertain on the basis of low-quality evidence to date. These investigators identified adults, aged 18 to 80 years, who met standard diagnostic criteria for major depressive disorder (MDD), had a history of at least 1 prior treatment episode, and had a clinician who was planning to either switch treatment or start a new treatment episode. All patients (N = 1944) underwent DNA collection and were then randomly assigned (concealed allocation) to either a group whose clinicians received the pharmacogenomic test results within 3 business days or a group whose clinicians had to wait 24 weeks for results. Clinicians in the pharmacogenomic-guided group initiated treatment based on the results; the clinicians in the delayed-results group initiated treatment as usual. Individuals masked to treatment group assignment assessed the treatment results using standard scoring tools at 4, 8, 12, 18, and 24 weeks. Complete follow-up occurred for 79% of patients at 24 months. Using intention-to-treat analysis, as expected, the pharmacogenomic-guided group was significantly more likely to receive treatment with an antidepressant with no potential drug-gene interaction. Remission rates were significantly increased in the gene-guided group at 8 and 12 weeks, but not at 4, 18, or 24 weeks. The authors note that there were multiple comparisons made without statistical corrections, so any results beyond the primary outcome of drug choice and remission at 24 weeks are subject to "fishing expedition" significance.