Abstract
We thank Dawes and colleagues 1 for their clarification on the features of their algorithm that we regretfully failed to mention in our recent review of pharmacogenetic testing options available in Canada. 2 We also would like to take this opportunity to acknowledge that several of the testing options we included in our review employed decision algorithms that may contain or have the capability to incorporate similar features (e.g., age, weight, current medications, renal, and liver functioning) that were highlighted by Dawes et al. but were not disclosed in the materials we used in our review. This is an inherent limitation to any review of commercially available pharmacogenetic testing options, resulting in part from the proprietary nature of several of the test manufacturer’s algorithms. These algorithms, often referred to as “black box” algorithms, deliberately conceal the features used and/or the process by which these features are translated into clinical recommendations. 3 Although the testing option highlighted by Dawes et al. is not an example of a black box algorithm, it is important to note that head-to-head trials comparing open and black box pharmacogenetic testing algorithms have yet to be published, and all randomized clinical trials of pharmacogenetic testing in psychiatry have utilized black box algorithms with unique features. 4 As such, there is currently not enough evidence to suggest any test or algorithm is superior to another. However, common sense would suggest that pharmacogenetic testing options that include clinical features commonly used to make medication selection and dosing decisions would better facilitate safer and more efficacious therapy for those with a psychiatric disorder.
Footnotes
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AAM, DJM, and CB are members of the Clinical Pharmacogenomics Implementation Consortium. CB is supported by the Cumming School of Medicine at the University of Calgary and the Alberta Children’s Hospital Research Institute. MF declares no conflicts. PDA holds the Alberta Innovates Translational Health Chair in Child and Youth Mental Health. KA has acted in a consulting capacity for companies including Roche Diagnostics, Bristol-Myers Squibb and Otsuka Pharmaceuticals Ltd, Otsuka Canada Pharmaceuticals Inc., Lundbeck, and HLS Therapeutics. She has also received research support from companies including Bristol-Myers Squibb and Otsuka Pharmaceuticals, Johnson and Johnson Research and Development, Jannsen Inc. Canada, and Roche Molecular Systems. DJM is coinvestigator in two pharmacogenetic studies where genetic test kits were provided as in-kind contribution by Assurex Health (Myriad Neuroscience) to evaluate feasibility of pharmacogenetic testing in clinical practice and potential benefits of pharmacogenetic testing compared to treatment as usual. DJM have not received any payments or received any equity, stocks, or options from this company or any other pharmacogenetic companies. DJM is coinvestigator in two filed genetic patents assessing risk of antipsychotic-induced weight gain. CB has received material support from Assurex Health (Myriad Neuroscience), CNSDose, Genomind, and AB-Biotics for research purposes and has ongoing research collaborations with CNSDose and MyDNA but does not have equity, stocks, or options in these companies or any other pharmacogenetic companies. CB, DJM and KA are members of the Genetic Testing Committee of the International Society of Psychiatric Genetics.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
