From the Guidelines
The GUIDED trial by Greden et al. (2019) demonstrated the potential benefits of guided medication selection using pharmacogenomic testing for patients with major depressive disorder, although the evidence is not directly related to the provided study. The provided study 1 discusses the effectiveness of self-guided cognitive behavioral therapy apps for depression, which is a different context from the GUIDED trial. However, it's essential to consider the GUIDED trial in the context of improving treatment outcomes for patients with major depressive disorder. The GUIDED trial evaluated the effectiveness of pharmacogenomic testing in guiding medication selection, which may be particularly helpful for patients who have failed multiple medication trials. Key points about the GUIDED trial include:
- The study found that patients whose treatment was guided by the GeneSight genetic test had modestly better outcomes compared to those receiving treatment as usual.
- The GeneSight test analyzes several genes involved in medication metabolism and response, categorizing medications into "green" (use as directed), "yellow" (moderate gene-drug interaction), and "red" (significant gene-drug interaction) categories.
- The trial included 1,167 patients with major depressive disorder who had failed at least one antidepressant treatment, and followed them for 8 weeks.
- While the primary outcome measure did not show statistically significant differences between groups, secondary outcomes showed that patients in the guided-treatment arm had higher response and remission rates. It's crucial to note that pharmacogenomic testing should complement, not replace, comprehensive clinical assessment and judgment in depression treatment. In real-life clinical practice, guiding medication selection using pharmacogenomic testing, as in the GUIDED trial, may be a valuable tool for improving treatment outcomes for patients with major depressive disorder, particularly those who have failed multiple medication trials.
From the Research
Guided Trial by Greden et al. (2019)
- The Guided trial, also known as the Genomics Used to Improve DEpression Decisions (GUIDED) trial, was a large, patient- and rater-blinded, randomized, controlled study that investigated the impact of pharmacogenomics on clinical outcomes in major depressive disorder 2.
- The study enrolled 1167 outpatients diagnosed with major depressive disorder (MDD) and with a patient- or clinician-reported inadequate response to at least one antidepressant.
- Patients were randomized to treatment as usual (TAU) or a pharmacogenomics-guided intervention arm in which clinicians had access to a pharmacogenomic test report to inform medication selections (guided-care).
- The primary outcome was symptom improvement at week 8, and secondary outcomes were response and remission at week 8.
Key Findings
- At week 8, symptom improvement for guided-care was not significantly different than TAU, but improvements in response and remission were statistically significant 2.
- Patients taking incongruent medications prior to baseline who switched to congruent medications by week 8 experienced greater symptom improvement, response, and remission compared to those remaining incongruent.
- Pharmacogenomic testing did not significantly improve mean symptoms but did significantly improve response and remission rates for difficult-to-treat depression patients over standard of care.
Comparison to Other Studies
- The GUIDED trial's findings are consistent with other studies that have investigated the effectiveness of guided self-help interventions for depression and anxiety, such as the study by Grist et al. (2019) which found that guided self-help was effective in reducing symptoms of depression and anxiety in adults 3.
- However, the GUIDED trial's focus on pharmacogenomics and its impact on clinical outcomes in MDD is unique and provides new insights into the potential benefits of guided care in this population.