Pharmacogenomics study to transform management of anxiety disorders

Anxiety disorders affect 3.4 million Australians, yet treatment remains a process of trial and error for many. Now, QIMR Berghofer researchers are calling on 5,000 adults diagnosed with or treated for an anxiety disorder to take part in a study that could transform the way these conditions are diagnosed, managed, and treated.

The Living with Anxiety (LwA) study aims to uncover the genetic and environmental factors influencing not just the risk of developing anxiety disorders, but also the likelihood of recovery.

“Around one-in-six (17.2%) Australians aged 16–85 years will experience an anxiety disorder in any given year. While anxiety disorders are often initially, and effectively, treated with psychological therapies, antidepressants are also commonly prescribed as a second-line, or concurrent treatment strategy,” said Professor Sarah Medland OAM, Head of the Psychiatric Genetics Group at QIMR Berghofer.

But not all treatments work the same way for everyone.

“Genetic variations influence our ability to metabolise, and respond to medicines, which can take time, and may involve ‘trial and error’, to determine the optimal treatment/antidepressant for an individual. During this period, a patient often experiences adverse reactions, and side-effects before the ‘right’ treatment is ascertained,” she explained.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-noradrenaline reuptake inhibitors (SNRIs) are the mainstays of pharmacological treatment for anxiety disorders, but their efficacy and safety profile varies. A recent Cochrane review found that agomelatine, duloxetine, escitalopram, and venlafaxine – manufactured by companies including Eli Lilly, Servier, Lundbeck, Viatris, and Sandoz – can improve treatment response rates, measured by at least a 50% reduction in symptoms on the HAM‐A scale.

However, an estimated one-in-five individuals using antidepressants will experience at least one distressing side effect, which can lead to discontinuation. Paroxetine, initially developed by GSK, has been associated with a higher dropout rate compared to other therapies.

“Large-scale investigations, such as the LwA study, can potentially contribute to minimising adverse reactions to medication through advancing pharmacogenomic testing,” said Professor Medland.

Despite its potential, pharmacogenomic testing remains out of reach for many patients, as only two tests are currently eligible for a Medicare Benefits Schedule (MBS) rebate: one is for detecting genetic variants in the thiopurine S-methyltransferase (TPMT) gene, which helps prevent dose-related toxicity during thiopurine drug treatment, and the other is for HLAB5701 testing prior to prescribing abacavir therapy.

According to Professor Nick Martin, Head of Genetic Epidemiology at QIMR Berghofer, small-scale pharmacogenomic studies have historically failed to reflect Australia’s diverse population.

“In addition, many of the genetic variants included in these studies are seen in less than 5% of the population,” said Professor Martin. “It is imperative we conduct larger studies, including participants with common patterns of co-occurring conditions, to better reflect the broader Australian population – the driver behind the LwA study.”

Professor Ian Hickie AO, Co-Director of Health & Policy at The University of Sydney Brain and Mind Centre, highlighted the importance of understanding co-occurring mental health conditions.

“Given anxiety often co-exists with other mental health issues, such as depression, we encourage those living with co-occurring mental health conditions, to also volunteer for the LwA study,” he said.

QIMR Berghofer researchers are urging healthcare professionals to help identify suitable patients for the study, which has the potential to reshape the future of anxiety disorder treatment. For those interested in participating, more information is available at Living with Anxiety or via email at lwa@qimrb.edu.au.

In reimagining healthcare across the entire patient journey, Health Industry Hub^TM is the only one-stop-hub uniting the diversity of the Pharma, MedTech, Diagnostics & Biotech sectors to inspire meaningful change.

The Health Industry Hub^TM content is copyright protected. Access is available under individual user licenses. Please click here to subscribe and visit T&Cs here.