Pharmacogenetic Testing, Therapeutic Drug Monitoring Feasible to Monitor Sertraline Concentrations in Residential Treatment Setting

Utilizing pharmacogenetic testing and therapeutic drug monitoring for sertraline is feasible in a child and adolescent residential treatment facility, according to research presented at the American Pharmacists Association (APhA) 2023 Annual Meeting and Exposition, held March 24-27, 2023, in Phoenix, Arizona.¹

Investigators conducted a prospective, open-label study of children with dose and CYP2C19 genotypes who were taking sertraline in order to compare concentrations of steady-state sertraline and demethylsertraline trough concentrations. Additional study objectives included an exploration of the feasibility of using pharmacogenetics and therapeutic drug monitoring in children and adolescents at a residential treatment center.

The study cohort included 20 participants (80% girls; mean age, 15.4 years; 65% White) who underwent pharmacogenetic testing and therapeutic drug monitoring. Forty percent of participants were diagnosed with generalized anxiety disorder and 30% were diagnosed with major depressive disorder.

Investigators found that average sertraline and desmethylsertraline concentrations were 21.1 ng/mL and 52.4 mcg/ml (range, 1-78 mcg/ml and 1-258 mcg/ml), respectively. Per CYP2C19 genotype, 60% of participants were normal metabolizers, 10% were intermediate metabolizers, and 30% were rapid metabolizers. Daily sertraline dose “accounted for a significant amount of the observed variability in sertraline and desmethylsertraline concentrations.”

When researchers compared weight-based dosing by sertraline and desmethylsertraline concentrations, they found that sertraline daily dose by weight also accounted for a “significant amount” of observed sertraline and desmethylsertraline variability.

“This small pilot study showed dose to be significantly associated with sertraline and desmethylsertraline concentrations,” the researchers wrote, adding that there were no noted differences among CPY2C19 metabolizer groups presumably due to the study’s small sample size. “These results also suggest that ordering pharmacogenetic testing and therapeutic drug monitoring in the setting of a child and adolescent residential treatment center is feasible,” they concluded.

References

1. Brown J, Ammend D, France KJ. Pharmacogenetic testing and therapeutic drug monitoring of sertraline at a residential treatment center for children and adolescents: A pilot study. Presented at: American Pharmacists Association 2023 Annual Meeting and Exposition; March 24-27, 2023; Phoenix, AZ. Poster 1237.