Episode 211: 211. Pharmacogenomics Testing, PHASER,
Questioning Medicine12 Heinä 2023

Episode 211: 211. Pharmacogenomics Testing, PHASER,


(https://www.healthquality.va.gov/guidelines/MH/mdd/VADoDMDDCPGFinal508.pdf) clearly state there is insufficient evidence to support this activity and testing. This is mainly because of low quality evidence and concern of bias given commercially funded studies.

(https://www.aafp.org/pubs/afp/issues/2023/0100/poems-pharmacogenic-testing-antidepressants.html)

American Psychiatric Association Psychiatry.org - Genetic Testing to Improve Psychiatric Medication Choice

Harvard https://www.health.harvard.edu/blog/gene-testing-to-guide-antidepressant-treatment-has-its-time-arrived-2019100917964

First prime


As I mention in my response email PRIME the primary outcomes per clinnicaltrials.gov were depression remission at 24 weeks, which was not statically significant. And then a use of fewer medications that have a potential gene-drug interaction which from what I can find was a ‘theoretical’ interaction not an actual increase in adverse events. Effect of Pharmacogenomic Testing for Drug-Gene Interactions on Medication Selection and Remission of Symptoms in Major Depressive Disorder: The PRIME Care Randomized Clinical Trial | Depressive Disorders | JAMA | JAMA Network




“The PREPARE Study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113234/#:~:text=Open%2Dlabel%20placebo%20reduced%20minimum,0.02%25%20in%20the%20TAU%20arm. When patients were told they were getting placebo for back pain and it helped their back pain!


The current VA/DoD guidelines clearly state, “For patients who cannot tolerate a statin, we suggest a washout period followed by a rechallenge with the same or a different statin or lower dose, and if that fails, a trial of intermittent (nondaily) dosing”.

https://www.healthquality.va.gov/guidelines/CD/lipids/VADoDDyslipidemiaCPG5087212020.pdf (full disclosure and bias I helped write them)

N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects | NEJM was published in the NEJM and then a few weeks later Statin treatment and muscle symptoms: series of randomised, placebo controlled n-of-1 trials (bmj.com) was published in the BMJ.

Around that same time a publication in JAMA https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773490 showed that using pharmacogenetic testing resulted in no worse LDL levels (soft endpoint) at one year but also no better


Jaksot(385)

Episode 375: 386. Could half dose anticoagulation be the answer?

Episode 375: 386. Could half dose anticoagulation be the answer?

Estimated 5-year incidence of recurrent VTE was similar in the reduced-dose and full-dose groups (2.2% and 1.8%). Estimated 5-year bleeding incidence was significantly lower with reduced-dose than wi...

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Episode 374: 385. PRACTICE CHANGER! Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis

Episode 374: 385. PRACTICE CHANGER! Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis

https://www.nejm.org/doi/full/10.1056/NEJMoa2405404NNT of 4! systemic metronid and topical clinda bid for one week

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Episode 373: 384. Chronic Kidney Disease and Empagliflozin Legacy Effect

Episode 373: 384. Chronic Kidney Disease and Empagliflozin Legacy Effect

What Was Studied?The EMPA-KIDNEY trial followed 6,609 CKD patients at risk of disease progression. Participants were randomly assigned to receive empagliflozin (10 mg daily) or a placebo for a median ...

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Episode 372: 383. What is the GFR at which we stop metforin?

Episode 372: 383. What is the GFR at which we stop metforin?

Metformin while not necessarily first line therapy for diabetes depending on the patients co-morbid conditions it is certainly highly ranked on the list of medications! I know often metformin is stopp...

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Episode 371: 382. Is it safe to give the flu and covid vaccine at the same time?

Episode 371: 382. Is it safe to give the flu and covid vaccine at the same time?

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825813Conclusions and Relevance  In this randomized clinical trial assessing simultaneous vs sequential administration of mRNA COVID-19 an...

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Episode 370: 381. Relative efficacy of prehabilitation interventions and their components

Episode 370: 381. Relative efficacy of prehabilitation interventions and their components

https://www.bmj.com/content/388/bmj-2024-081164systematic review and meta-analysis on prehabilitation before surgery, published in the BMJ in February 2025.Prehabilitation aims to prepare patients for...

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Episode 369: 380. REPOST mammo part 2

Episode 369: 380. REPOST mammo part 2

Mammograms

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Episode 368: 379. REPOST mammogram part 1

Episode 368: 379. REPOST mammogram part 1

379. REPORT mammogram part 1

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