Ahmed T Ahmed1, Joanna M Biernacka2, Gregory Jenkins2, A John Rush3, Gen Shinozaki4, Marin Veldic1, Simon Kung1, William V Bobo5, Daniel K Hall-Flavin1, Richard M Weinshilboum6, Liewei Wang6, Mark A Frye7. 1. Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States. 2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States. 3. Duke-National University of Singapore, Singapore; Department of Psychiatry, Duke Medical School, Durham, NC, United States; Texas Tech University-Health Sciences Center, Permian Basin, TX, United States. 4. Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States. 5. Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa, United States; Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL, United States. 6. Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States. 7. Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, United States. Electronic address: mfrye@mayo.edu.
Abstract
BACKGROUND: The purpose of this study was to identify specific pharmacokinetic (PK) and pharmacodynamics (PD) factors that affect the likelihood of treatment remission with a serotonin norepinephrine reuptake inhibitor (SNRI) in depressed patients whose initial selective serotonin reuptake inhibitor (SSRI) failed. METHODS: Multiple logistic regression modeling of PK and PD variation hypothesized to contribute to SNRI (i.e. duloxetine or venlafaxine) treatment remission in prior SSRI (i.e. citalopram or escitalopram) failure was conducted on 139 subjects from the Pharmacogenomics Research Network (PGRN) and Sequenced Treatment Alternatives to Relieve Depression (STAR*D) studies. Depressive symptoms were assessed with the Quick Inventory of Depressive Symptomatology Clinician-rated (QIDS-C16). RESULTS: Venlafaxine-XR remission was associated with a significant interaction between CYP2D6 ultra-rapid metabolizer (URM) phenotype and SLC6A4 5-HTTLPR L/L genotype. A similar significant interaction effect was observed between CYP2D6 URM and SLC6A2 G1287A GA genotype. Stratifying by transporter genotypes, venlafaxine-XR remission was associated with CYP2D6 URM in patients with SLC6A4 L/L (p = 0.001) and SLC6A2 G1287A GA genotypes. LIMITATIONS: The primary limitation of this post hoc study was small sample size. CONCLUSION: Our results suggest that CYP2D6 ultra-rapid metabolizer status contributes to venlafaxine-XR treatment remission in MDD patients; in particular, there is a PK-PD interaction with treatment remission associated with CYP2D6 URM phenotype and SLC6A4 5-HTTLPR L/L or SLC6A2 G1287A G/A genotype, respectively. These preliminary data are encouraging and support larger pharmacogenomics studies differentiating treatment response to mechanistically different antidepressants in addition to further PK-PD interactive analyses.
BACKGROUND: The purpose of this study was to identify specific pharmacokinetic (PK) and pharmacodynamics (PD) factors that affect the likelihood of treatment remission with a serotoninnorepinephrine reuptake inhibitor (SNRI) in depressedpatients whose initial selective serotonin reuptake inhibitor (SSRI) failed. METHODS: Multiple logistic regression modeling of PK and PD variation hypothesized to contribute to SNRI (i.e. duloxetine or venlafaxine) treatment remission in prior SSRI (i.e. citalopram or escitalopram) failure was conducted on 139 subjects from the Pharmacogenomics Research Network (PGRN) and Sequenced Treatment Alternatives to Relieve Depression (STAR*D) studies. Depressive symptoms were assessed with the Quick Inventory of Depressive Symptomatology Clinician-rated (QIDS-C16). RESULTS:Venlafaxine-XR remission was associated with a significant interaction between CYP2D6 ultra-rapid metabolizer (URM) phenotype and SLC6A45-HTTLPR L/L genotype. A similar significant interaction effect was observed between CYP2D6 URM and SLC6A2G1287A GA genotype. Stratifying by transporter genotypes, venlafaxine-XR remission was associated with CYP2D6 URM in patients with SLC6A4 L/L (p = 0.001) and SLC6A2G1287A GA genotypes. LIMITATIONS: The primary limitation of this post hoc study was small sample size. CONCLUSION: Our results suggest that CYP2D6 ultra-rapid metabolizer status contributes to venlafaxine-XR treatment remission in MDDpatients; in particular, there is a PK-PD interaction with treatment remission associated with CYP2D6 URM phenotype and SLC6A45-HTTLPR L/L or SLC6A2G1287A G/A genotype, respectively. These preliminary data are encouraging and support larger pharmacogenomics studies differentiating treatment response to mechanistically different antidepressants in addition to further PK-PD interactive analyses.
Authors: Andrea R Collins; Simon Kung; Jacqueline T Ho; Jessica A Wright; Kristina C Dammen; Emily K Johnson; Maria I Lapid; Jonathan G Leung Journal: J Psychiatr Res Date: 2020-05-10 Impact factor: 5.250
Authors: Marin Veldic; Ahmed T Ahmed; Caren J Blacker; Jennifer R Geske; Joanna M Biernacka; Kristin L Borreggine; Katherine M Moore; Miguel L Prieto; Jennifer L Vande Voort; Paul E Croarkin; Astrid A Hoberg; Simon Kung; Renato D Alarcon; Nicola Keeth; Balwinder Singh; William V Bobo; Mark A Frye Journal: Front Pharmacol Date: 2019-02-19 Impact factor: 5.810