Pharmacogenomic Profiling of Pediatric Patients on Psychotropic Medications in an Emergency Department

被引:2
|
作者
Ghosh, Pallavi [1 ]
Martinez, Jesse [2 ]
Shah, Nipam [1 ]
Kenan, Will [3 ]
Fowler, Andrew [4 ]
Limdi, Nita [5 ]
Burns, Lindsey [6 ]
Cogan, Elizabeth S. [7 ]
Gardiner, Anna [7 ]
Hain, Daniel [6 ]
Johnson, Holly [6 ]
Lewis, David [6 ]
Shelton, Richard [8 ]
Liebelt, Erica [1 ,9 ]
机构
[1] Univ Alabama Birmingham, Dept Pediat, Div Pediat Emergency Med, Heersink Sch Med, Birmingham, AL 35233 USA
[2] Univ Alabama Birmingham, Heersink Sch Med, Dept Psychiat & Behav Neurobiol, Div Child & Adolescent Psychiat, Birmingham, AL 35233 USA
[3] Univ Alabama Birmingham, Dept Biomed & Hlth Sci, Sch Hlth Proc, Birmingham, AL 35233 USA
[4] Univ Arkansas Med Sci, Coll Med, Arkansas Childrens Hosp, Pediat Residency Program, Little Rock, AR 72205 USA
[5] Univ Alabama Birmingham, Heersink Sch Med, Dept Neurol, Birmingham, AL 35233 USA
[6] Myriad Neurosci, Mason, OH USA
[7] Myriad Genet Inc, Salt Lake City, UT USA
[8] Univ Alabama Birmingham, Dept Psychiat, Heersink Sch Med, Birmingham, AL 35233 USA
[9] Univ Arkansas Med Sci, Sect Pediat Emergency Med & Pharmacol & Med Toxic, Dept Pediat, Little Rock, AR 72205 USA
关键词
combinatorial pharmacogenomic testing; psychiatric disorders; psychotropic medications; pediatric population; blood levels; MAJOR DEPRESSIVE DISORDER; ANTIDEPRESSANT TREATMENT; IMPACT; TRIAL;
D O I
10.1097/PEC.0000000000002871
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: The aim of the study was to evaluate the ability of a combinatorial pharmacogenomic test to predict medication blood levels and relative clinical improvements in a selected pediatric population. Methods: This study enrolled patients between ages 3 to 18 years who presented to a pediatric emergency department with acute psychiatric, behavioral, or mental health crisis and/or concerns, and had previously been prescribed psychotropic medications. Patients received combinatorial pharmacogenomic testing with medications categorized according to gene-drug interactions (GDIs); medications with a GDI were considered "incongruent," and medications without a GDI were considered "congruent." Blood levels for escitalopram, fluoxetine, aripiprazole, and clonidine were evaluated according to level of GDI. Relative clinical improvements in response to the prescribed psychotropic medications were measured using a parent-rated Clinical Global Impression of Improvement (CGI-I) assessment, where lower scores corresponded with greater improvement. Results: Of the 100 patients enrolled, 73% reported taking >= 1 incongruent medication. There was no significant difference in CGI-I scores between patients prescribed congruent versus incongruent medications (3.37 vs 3.68, P = 0.343). Among patients who presented for depression or suicidal ideation, those prescribed congruent medications had significantly lower CGI-I scores compared with those taking incongruent medications (P = 0.036 for depression, P = 0.018 for suicidal ideation). There was a significant association between medication GDI and blood levels for aripiprazole (n = 15, P = 0.01) and escitalopram (n = 10, P = 0.01). Conclusions: Our preliminary findings suggest that combinatorial pharmacogenomic testing can predict medication blood levels and relative outcomes based on medication congruency in children presenting to an emergency department with acute psychiatric/behavioral crises. Additional studies will be needed to confirm these findings.
引用
收藏
页码:6 / 12
页数:7
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