Meta-analysis of Response and Remission Outcomes With a Weighted Multigene Pharmacogenomic Test for Adults With Depression.

Abstract

Purpose/background: Multiple meta-analyses have suggested that pharmacogenomic (PGx) testing may be a valuable tool to improve clinical outcomes for patients with major depressive disorder (MDD) who have failed at least one treatment. However, these meta-analyses included studies with different PGx tests and different trial designs, which produce uncertainty when interpreting results. To investigate the clinical utility of a single weighted multigene PGx test, a meta-analysis was performed for prospective studies utilizing this PGx test in adult patients with MDD.

Methods/procedures: MEDLINE/PubMed and Cochrane [including Embase, clinicaltrials.gov, and International Clinical Trials Registry Platform (ICTRP)] were searched through May 2025 for studies evaluating the impact of pharmacogenomic testing on outcomes for patients with MDD. Using PRISMA guidelines, 243 records were identified, and 6 studies were included that compared PGx-guided care to unguided care in adult patients with MDD, using a single weighted multigene test.

Findings/results: Overall, 3,532 patients were included, with outcomes evaluated at week 8 or week 10. Patients with MDD whose care was guided by the weighted multigene PGx test were 30% more likely to achieve response [relative risk ratio (RR)=1.30, 95% CI: 1.16-1.47, P<0.001] and 41% more likely to achieve remission [RR=1.41, 95% CI: 1.19-1.66, P<0.001] compared to unguided care. No heterogeneity in outcomes across studies was detected.

Implications/conclusions: Prescribing informed by a weighted multigene PGx test significantly improved response and remission rates among adult patients with MDD who experienced at least 1 prior treatment failure, further demonstrating the clinical utility of weighted multigene PGx testing.