抗うつ薬治療を個別化するデジタルツールが治療成績を改善（Digital tool that personalises antidepressant treatment significantly improves outcomes of people with depression）

2026-03-06

2026-03-04 オックスフォード大学

英国オックスフォード大学の研究チームは、うつ病治療において患者ごとに最適な抗うつ薬を選択するデジタル支援ツールを開発し、治療効果を大きく改善できることを示した。研究では、患者の症状、病歴、副作用の傾向など複数の臨床情報を解析して最適な薬剤を提案するアルゴリズムを用い、臨床試験で通常の治療方法と比較した。その結果、このツールを利用した場合、患者が症状の改善を示す割合が有意に高く、治療効果が向上することが確認された。うつ病治療では薬の選択が試行錯誤になりやすく、効果が出るまでに長い時間がかかることが課題とされている。本ツールは医師の治療判断を補助し、より迅速で個別化された治療を可能にすることで、患者の回復を早め医療効率の向上にも貢献する可能性がある。

＜関連情報＞

大うつ病性障害における抗うつ薬治療を個別化するための意思決定支援システムランダム化臨床試験 A Decision-Support System to Personalize Antidepressant Treatment in Major Depressive Disorder A Randomized Clinical Trial

Andrea Cipriani, MD, PhD; Karen Barros Parron Fernandes, PhD; Benoit H. Mulsant, MD;et al
Journal of the American Medical Association Published:March 4, 2026
DOI:10.1001/jama.2026.1327

Key Points

Question Does the PETRUSHKA tool, a web-based clinical decision-support system combining clinical and demographic predictors with patient preferences to personalize antidepressant treatment, improve clinical outcomes of people with major depressive disorder?

Findings In this international, randomized clinical trial including 520 adults with major depressive disorder, patients who received a personalized antidepressant selected using the PETRUSHKA tool were less likely to discontinue their treatment due to any reason at 8 weeks compared with participants treated by their clinicians under usual care conditions (41/241 [17%] vs 69/252 [27%], respectively; adjusted relative risk, 0.62 [95% CI, 0.44-0.88]; P = .007).

Meaning In adults with major depressive disorder, the PETRUSHKA tool was effective in personalizing antidepressant treatment and increased the likelihood of continuing treatment through 8 weeks.

Abstract

Visual Abstract.

Importance Antidepressants for moderate to severe major depressive disorder may be discontinued prematurely because the prescribed antidepressant is not always the most appropriate medication for an individual. Guidelines have recommended more precise targeting of antidepressant treatment.

Objective To evaluate the efficacy of a web-based tool to personalize antidepressant treatment.

Design, Setting, and Participants This multicenter, randomized clinical trial included persons between the ages of 18 and 74 years with major depressive disorder. The trial was conducted at 47 sites in 3 countries (Brazil, Canada, and the UK). The first participant was screened on November 29, 2022, and the last follow-up visit occurred on January 15, 2025.

Intervention A total of 540 participants were randomized (1:1) to an evidence-based clinical decision-support system (PETRUSHKA tool; n = 271) or usual care (n = 269).

Main Outcomes and Measures The primary outcome was treatment discontinuation due to any cause at 8 weeks. The secondary outcomes included treatment discontinuation up to 24 weeks due to adverse events and changes in depressive symptoms (measured with the 9-item Patient Health Questionnaire [PHQ-9]; range, 0-27; higher scores indicate more severe depression) and anxiety symptoms (measured with the 7-item Generalized Anxiety Disorder [GAD-7] questionnaire; range, 0-21; higher scores indicate more severe symptoms).

Results Of the 520 eligible participants, 493 were included in the primary analysis (median age, 35 [IQR, 25 to 48] years; 58% female; PHQ-9 mean score, 16.6 [SD, 5.1]; GAD-7 mean score, 11.5 [SD, 4.1]). At 8 weeks, 41 of 241 participants (17%) in the PETRUSHKA group discontinued the prescribed antidepressant due to any cause vs 69 of 252 (27%) in the usual care group (adjusted relative risk, 0.62 [95% CI, 0.44 to 0.88]; P = .007). At 8 weeks, 22 of 241 participants (9%) in the PETRUSHKA group discontinued the prescribed antidepressant due to adverse events vs 39 of 252 (16%) in the usual care group (adjusted relative risk, 0.59 [95% CI, 0.36 to 0.97]; P = .04). For the assessment of depressive symptoms at 24 weeks, the mean PHQ-9 score was 7.1 (SD, 5.4) in the PETRUSHKA group vs 9.2 (SD, 6.5) in the usual care group (n = 129 in each group; adjusted between-group mean difference, −1.92 [95% CI, −3.06 to −0.78]; P < .001). For the assessment of anxiety symptoms at 24 weeks, the mean GAD-7 score was 4.6 (SD, 4.1) in the PETRUSHKA group (n = 133) vs 5.8 (SD, 4.9) in the usual care group (n = 126) (adjusted between-group mean difference, −1.39 [95% CI, −2.26 to −0.52]; P = .002).

Conclusions and Relevance Compared with usual care, use of the PETRUSHKA tool increased the number of patients still taking their antidepressant at 8 weeks and improved depressive and anxiety symptoms at 24 weeks. However, lack of a double-blind design and the large amount of missing data limit the validity of these results.

Trial Registration ClinicalTrials.gov Identifier: NCT05608330