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Pharmacogenetics allows for better targeting of medicines in mental health

by

Denis Méthot

June 7, 2019 09:30

Antoine Bégin | Photo : Denis Méthot

In the field of mental health and depression, the doctors perform a lot of trials and errors. They prescribe medicines and, if they did not give the expected results, they try something else. However, there is a test pharmacogenetics, failing to determine the optimal treatment for patients, allows to eliminate the medication, the less appropriate and hence less effective for them.

Studies have shown two depressive patients on three will not be in remission after the first treatment, 38 % of patients do not respond well to antidepressants, and in 25% of them, the severe side effects are going to prevent them from functioning. The chances of success decrease after each treatment strategy, which shows according to the experts the limits of the trial and error method current.

Yet, even if the results are not optimal, the drugs remain useful, said Antoine Bégin, of BiogeniQ, a young company specialised in the genetics, which is now part of the group, Biron. It is proved that antidepressants work, but not necessarily for everyone, he said during the congress training Segic introduced recently in Quebec.

It often takes time to find the right treatment for the right person, wait two to four weeks before the doctor confirms whether it works well or not. If it doesn’t work, then do a purge, a transition from one week to change an anti-depressant or another. These delays have costs, both for the psychological health of the employee and the employer.

Slow metabolism and fast metabolism

BiogeniQ has a technology, a test pharmacogenetics, which allows you to know if patients respond poorly to some drugs. For the moment, this test is limited to the area of mental health. “When we did a test pharmacogenetics, it is not a test for diseases or for cancer, has insisted Antoine Bégin. You don’t have that information. “

The collection is not invasive. It is done by the saliva in a tube. It takes the cells to the inside of the cheeks, and white blood cells from the saliva. Genes have an impact on the metabolism. In some individuals, the metabolism is ultra fast for some drugs. It breaks down the medication so fast that it doesn’t act, or that it is necessary in these patients very high doses to achieve the desired effect. When these people absorb such a molecule, it is as if they were taking a glass of water, illustrates the sales manager of BiogeniQ.

For others, their metabolism degrades so slowly the medication that it can cause serious problems in terms of toxicity. When these patients are taking a medication for mental health, the effect of the first dose is correct. But as soon as they take the second, the concentration builds up and they feel a lot of side effects because they have too much concentration of the drug in the blood. Them will say that they need a very small amount or that they are allergic to antidepressants.

The role of pharmacogenetics

The role of pharmacogenetics is used to identify the drugs that will be metabolized too quickly, or too slowly, and those who have less risk of does not work.

Thanks to this test, the patient will be able to know if such a drug has less of a chance that it works well.

However, this technology does not yet allow us to determine what drug will work best for the patient, wished to clarify Antoine Bégin. What the test reveals, it is which antidepressant suits him less. “In ten years, he said, we will be able to tell you what will be on the right medication appropriate for a person, but for the moment, the test is like a filter : it is able to eliminate those who have the least chance to work. “

For the two patients out of three for which the first drug does not, the impact of this test may nevertheless be highly significant in adherence to the treatment. Studies in mental health on the use of this test among employees have shown that when their medication was matched to their DNA, they were two times more likely to be in remission after two months than those who had not done so. It was also observed an increase of compliance.

“What we saw in pharmacogenetics, said Antoine Bégin, is that when a patient received a medication which is tailored to his DNA, he was more inclined to take it, because the drug was not prescribed to the blind, but suitable for him. “

The average duration of disability short-term due to mental health lies in four months. Among clients of BiogeniQ, it was found that the use of DNA testing has resulted in an average reduction in time of disability of two weeks. The test has also been passed by people who were not on disability leave, but who were taking medication and who were experiencing side effects. It was observed a reduction of symptoms and an increase in productivity of 20 %, which is very positive for an employer.

The doctors in the face of pharmacogenetic testing

How doctors react to these pharmacogenetic testing ? Do they put the results in the trash without worrying about it by issuing the order ? All in all, they seem to be very receptive, was seen to confirm Antoine Bégin interviews with patients and physicians themselves. 80% had a favourable attitude, 10 % were neutral and 10 % were unfavourable. After sending the results of the tests, rejoices in it, in 51 % of prescriptions, the doctor had changed the dosage or the medicine.

Due to the potential of pharmacogenetic testing to save costs, BiogeniQ has other projects in chronic pain, cardiology and ADHD.

“This test, to conclude Antoine Bégin, can have a very nice impact in a company, but the potential is enhanced when it is embedded in an approach of accompaniment, follow-up. “

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