Subanalysis of the CYP-GUIDES Trial: CYP2D6 Functional Stratification and Operational Timeline Selection

Psychiatry Res. 2021 Mar;297:113571. doi: 10.1016/j.psychres.2020.113571. Epub 2020 Nov 15.


CYP-GUIDES (Cytochrome Psychotropic Genotyping Under Investigation for Decision Support) was a Randomized Controlled Trial comparing 2 outcomes in hospitalized patients with major depressive disorder treated according to the patient's CYP2D6 genotype and functional status versus standard psychotropic therapy. The primary outcome was hospital Length of Stay (LOS) and the secondary was Re-Admission Rate (RAR) 30 days after discharge. Methodology, total results and database of the trial have been published. Here we present a subanalysis that isolated 3 confounders to assess the impact of CYP2D6 therapeutic guidance on LOS: a single Electronic Medical Record, a minimum 3-day LOS, and CYP2D6 functional stratification of patients. CYP2D6 functional stratification enabled subgrouping patients and comparing outcomes according to CYP2D6 functionality within Group G and Group S. Subfunctional patients evidenced a 2-day shorter LOS in Group G compared to Group S. Drug administration for subfunctional patients in Group S evidenced a higher percentage of CYP2D6 substrate psychotropics being prescribed as well as a greater number of prescriptions than in functional patients. We conclude that there was an effect of pharmacogenetic clinical decision support that reduced LOS in patients with CYP2D6 subfunctional status and reduced prescribing of CYP2D6 substrate dependent drugs.

Keywords: CYP2D6 pharmacogenetics; clinical decision support; major depressive disorder; psychiatric hospitalization; psychotropic utilization.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Clinical Decision-Making*
  • Cytochrome P-450 CYP2D6* / genetics
  • Depressive Disorder, Major / drug therapy*
  • Female
  • Humans
  • Length of Stay*
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care*
  • Pharmacogenetics*
  • Psychotropic Drugs / therapeutic use*


  • Psychotropic Drugs
  • Cytochrome P-450 CYP2D6