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Dynamic and accessible pharmacogenomic results: a response to pharmacogenomic testing for antidepressant treatment selection

Neuropsychopharmacology volume 49, page 769 (2024)Cite this article

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We thank Drs. Frye and Nemeroff for their perspective on the promising role of pharmacogenetics (PGx) in the selection of antidepressant treatment [1]. In their article, Frye and Nemeroff discuss several challenges to the wide-scale application of PGx for the treatment of depression. We agree that there are several challenges to address, particularly regarding electronic health record (EHR) integration, in order for PGx to become a widely utilized resource for antidepressant selection and dosing.

EHR functionality is required for PGx implementation to succeed, including readily accessible, discrete results and integrated clinical decision support (CDS). PGx laboratory results are shared in several ways with patients and providers: as paper reports which are subsequently scanned into the EHR and/or manually entered into a patient’s chart; as electronic files uploaded into the media section of the EHR; in patient or provider-facing websites independent of the EHR; or as laboratory results directly transmitted via HL7 messaging. Returning results and providing CDS in static formats, such as electronic files, do not allow for the interpretation or prescribing recommendations to change as PGx knowledge evolves. For example, the 2023 Clinical Pharmacogenetics Implementation Consortium (CPIC) serotonin reuptake inhibitor guidelines provide actionable recommendations for sertraline based on CYP2B6 metabolizer status, whereas previous CPIC serotonin reuptake inhibitor guidelines did not [2, 3]. CDS returned in electronic file formats prior to 2023 would not contain CYP2B6/sertraline recommendations, therefore not reflecting current consensus. To ensure accurate and high-quality patient care, CDS must be revised periodically and dynamically changed as evidence and treatment recommendations are updated.

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References

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Authors and Affiliations

  1. UPMC Western Psychiatric Hospital Department of Pharmacy, Pittsburgh, PA, USA

    Christina N. Sun

  2. University of Pittsburgh School of Pharmacy Department of Pharmacy and Therapeutics, Pittsburgh, PA, USA

    Lucas A. Berenbrok

  3. Johns Hopkins University School of Medicine Department of Medicine, Division of Clinical Pharmacology, Baltimore, MD, USA

    James M. Stevenson

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  1. Christina N. Sun
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  2. Lucas A. Berenbrok
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  3. James M. Stevenson
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Christina Sun drafted the initial correspondence manuscript. Lucas Berenbrok and James Stevenson provided guidance regarding discussion points and reviewed and edited the manuscript.

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Correspondence to Christina N. Sun.

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Sun, C.N., Berenbrok, L.A. & Stevenson, J.M. Dynamic and accessible pharmacogenomic results: a response to pharmacogenomic testing for antidepressant treatment selection. Neuropsychopharmacol. 49, 769 (2024). https://doi.org/10.1038/s41386-024-01816-3

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