Precision medicine can increase treatment quality of mental disorders
The EU project REALMENT will make use of so-called Real World Data (RWD), genetic profiles and artificial intelligence (AI) to increase the quality of treatment for patients with mental disorders.
Professor Ole Andreassen leads the EU project REALMENT. Photo: Kirsten Sjøwall.
Mental illness poses a great burden on those that are affected and constitutes high costs for the health sector. Today’s drug therapy alternatives are not effective for all patients, and many patients struggle with side effects. The EU project REALMENT wants to do something about this.
– We will use genetic profiles to optimise the use of existing medications. In that way, we can reduce side effects and increase the effects of the treatment for patients with mental disorders. To bring about such precision psychiatry, we will make use of large data sets from electronic health records and registers, as well as new methods such as machine learning and artificial intelligence, explains Professor Andreassen.
He is Professor at the Institute of Clinical Medicine at the University of Oslo and leads the Norwegian Center for Mental Disorders Research (NORMENT). Professor Andreassen coordinates the EU project REALMENT.
Slow progress in the development of medications
There has been made great progress in the development of medications for many diseases in recent years. But this progress has not taken place within the field of mental health. The medications that are used to treat schizophrenia, bipolar disorders and depression today are relatively old, have varied treatment effects, and can cause major side effects.
Many patients therefore choose not to take the medication that they are prescribed.
–There are effective medications for treatment, but they often cause many side effects. For example, there is lithium from 1950 that, among others, might cause tremor. But it’s not easy to discover new medications that can replace the ones that we use today, says the researcher.
Want a better customisation of medications to patients
– Many pharmaceutical companies have given up on the psychiatric field and are primarily focused on other fields in medicine, such as for example immunotherapy and cancer treatment. But we cannot lean back and watch patients suffer from side effects or poor treatment effects, states Professor Andreassen, and continues:
–This means that we need to make sure that medications that are already available, are used in a better way. We need to give the right doses and reduce side effects as much as possible. Instead of waiting for new medications to be developed in the future, we want to customise the use of existing medications better based on available data, he says.
Large Real World Data portfolios
The EU wants researchers to make better use of the possibilities that lies in Real World Data (RWD) portfolios. The REALMENT project will make use of large amounts of data from Scandinavian health registers and hospitals, as well as from European biobanks and British Electronic Health Records (EHRs). These are all examples of RWD.
– We cannot develop prediction models for precision medicine based on small groups, for example a clinical study with a few hundred people. But it is a big advantage that we can make use of large amounts of data that have already been collected in the health sector in various European countries. In the Scandinavian cohorts we have data from almost one million people, explains Professor Andreassen, and continues:
– So, we will combine the large data portfolios from population studies with data from smaller, clinical studies – so-called Randomized Controlled Trials (RCTs). In this way we can get the most from both.
Can predict treatment outcomes
By studying both environmental factors and genetic variants the researchers will identify a number of risk factors that influence treatment outcomes for patients.
–Our goal is to get an overview of risk factors for mental disorders. We can put these into a model that, through algorithms, will be able to predict different treatment outcomes for each individual patient, he explains.
Over time, the researchers hope to develop a clinical platform where it will be possible to individualise the treatment of patients in psychiatric health care.
– We think that it is difficult to get an overview of all risk factors of each individual patient and doctor. The goal is therefore to create a platform where we gather all relevant information, the Professor says.
Heart attack as an example
Professor Andreassen explains by using cholesterol and heart attack as an example.
– You can measure cholesterol levels, which is a risk factor for heart attack, long before the condition occurs. We want to find similar risk factors within psychiatry, but there is probably not one single factor, he explains.
– So, with the example of heart attack, it is not enough to merely measure cholesterol levels, because there are additional risk factors such as smoking, being overweight, risk factors in the family, and an unhealthy diet. There are thus five risk factors, and if you put these together you can make a risk model. For mental disorders there are several risk factors, both environmental factors and many genetic factors. In addition, stressful conditions in the family and at work also play an important role, as well as lifestyle and, of course, life events.
Professor Andreassen hopes that the knowledge from the REALMENT project can contribute to the development of a platform that can be useful for doctors and therapists in psychiatry.
It can give a pointer as to which medications may work better for each individual patient, whether a patient should have a closer follow-up due to high risk, or whether the patient should rather try psychotherapy if there is a considerable risk of major side effects from the drugs.
Cooperation between world-leading researchers and the industry
The REALMENT project is comprised of world-leading researchers within research on mental disorders and industrial partners within the health industry and pharmaceutical companies.
Professor Andreassen is the project's coordinator, and the allocation is therefore considered an important recognition of the work at the University of Oslo.
–The research team behind the application is highly experienced and outstanding, and received the maximum score in the evaluation. They are going to use large data sets and information technology to give us knowledge about a better and more precise treatment of mental illnesses, says Pro-Dean for research Jens Petter Berg.
– We congratulate project leader Professor Ole Andreassen and his team with the funding allocation to REALMENT. I would like to wish them all the best with the execution of the project, concludes Berg.