EHRs combined with precision medicine can improve depression treatment

DNA

Using genetic information in a patient’s electronic health record can help pinpoint which antidepressant drugs should be prescribed and in what amounts, according to a new article in Mayo Clinic Proceedings.

There are more than 20 Food and Drug Administration-approved treatments for depression. However, genetic variations among patients may contribute to the effectiveness of different treatments and to adverse events. For example, cytochrome P4502D6 (CYP2D6) and cytochrome P4502C19 (CYP2C19) are subject to genetic variation and metabolize differently with different selective serotonin reupdate inhibitors (SSRIs). However, many clinicians are not familiar or comfortable with pharmacogenetics, despite growing evidence of its clinical importance.

The researchers created a clinical decision support guideline linked to web-based educational material to provide up-to-date information on a patient’s genotype and subsequent prescribing recommendations when there is a high risk of a problem. For example, when prescribing SSRIs fluoxetine, paroxetine or venlafaxine to a patient who is a poor or poor to intermediate CYP2D6 metabolizer, an alert will appear on the computerized physician order entry (CPOE) system to enable the prescriber to reduce the dose or prescribe a different medication.

The researchers noted that the guideline that was developed applies only to patients for whom the genotype is already known and in the EHR, but said that at some point, preemptive precision medicine could improve patient safety.

“With the continuous decrease in the cost of genetic testing, the willingness of insurance companies to cover such tests, and the increase in published data providing more robust evidence of clinical importance, CYP2D6/CYP2C19 genotyping might become, in the near future, a routine test before prescribing relevant antidepressants to all patients,” they said. 

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