Name:
McCarthy- When to Consider Pharmacogenomic Testing for your Patient
Description:
McCarthy- When to Consider Pharmacogenomic Testing for your Patient
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Upload Date:
2022-02-27T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Hi, I'm Jeanette McCarthy from Precision Medicine Advisors, and in this brief video we'll talk about when to consider pharmacogenomic testing on your patients.
Segment:1 Heterogeneous Response to Drugs.
Response to prescription therapeutics is highly variable. Not all patients benefit from these medicines, and some are even harmed. Pharmacogenomics uses genetic information from the patient to offer individualized treatment with the goal of improving the efficacy and decreasing the side effects of prescription drugs.
Segment:2 Is Pharmacogenomics Right for My Patient?.
So how do I know if pharmacogenomic testing is right for my patient? Well, there're several things to consider. First is there a pharmacogenomic test available? One can often determine this by reading the drug label, but a more comprehensive source is the searchable PharmGKB database. Second is the test any good? The best tests are typically supported by professional guidelines, but pharmacogenomic tests have their own sets of guidelines as well, from the US Clinical Pharmacogenetics Implementation Consortium, or CPIC.
These guidelines can also be found on the PharmGKB website. Third how do I interpret the test results? CPIC guidelines offer interpretation and recommendations for individualizing treatments. Fourth is the test covered by insurance? This really varies from test to test and from one insurance company to the next. You'll have to consult with different insurance plans to know if the tests are covered.
Healthcare providers should also consider though, that the patients may want to pay out of pocket and that economical pharmacogenomics panels are available through some labs. Finally, how do you find a pharmacogenomics testing lab? Pharmacogenomic testing labs can be found through the Community Pharmacist Pharmacogenetics Network, the Genetic Testing Registry, or at nextgxdx.com.
Segment:3 When to Consider Pharmacogenomics.
Now I'd like to present several scenarios where you should consider pharmacogenomic testing for your patient.
The first scenario is the case where a drug really only works in people with a specific biomarker. This is the situation for many targeted therapies in cancer, as well as a small handful of drugs in other therapeutic areas. An example of a drug that only works in patients with specific mutations is the drug Kalydeco used to treat Cystic Fibrosis. The mechanism of drug is intricately linked to the specific mutations causing the disease. The drug lacks efficacy in patients without these specific mutations and should not be given to them.
Other examples of pharmacogenomic tests that should always be considered are for drugs where there is a high risk of death from side effects, things like Toxic Epidermal Necrolysis and Stevens-Johnson syndrome. Pharma-- pharmacogenomic tests can be used to rule out these life-threatening side effects which occur for drugs used to treat diseases like epilepsy, gout, and HIV infection. Another use case for pharmacogenomic testing is in cases where empirical dosing just isn't good enough.
These would be situations where delays in treatment, even by a few days, could impact survival. Take, for example, a patient with myeloid leukemia who develops myelosuppression after treatment with combination therapy, including Thioguanine. This serious side effect can delay treatment as doctors try to figure out the cause of myelosuppression.
Pharmacogenomic testing can reveal those patients at risk of this side effect who should start with dramatically decreased doses of Thiopurine, or using alternative therapy in order to reduce their risk of myelosuppression. Pharmacogenomic testing could also be considered based on a personal history of non-response to drugs or a history of adverse drug reactions. Take, for example, a patient with apparent treatment-resistant depression. Pharmacogenomic testing on this patient might reveal that the cause of their treatment resistance is genetic.
Testing could indicate that other treatments might be more efficacious in this patient. Take another example of a patient who during a routine annual physical reveals to you a history of fainting after taking codeine. You suspect that the fainting may be a sign that the patient is a genetic rapid metabolizer of codeine, where normal doses can lead to a toxic amount of codeine's active metabolite morphine. Pharmacogenomic testing could confirm this, leading you to recommend future avoidance or reduced doses of codeine to avoid toxic side effects.
It's often difficult to decide to order a pharmacogenomic test at the time of prescribing a drug. And yet, we know that pharmacogenomic information can help deliver the right drug at the right dose to patients. I asked students of mine in a pharmacogenomics course about a specific pharmacogenomic test, and whether they would be likely to order the test for their patients. About half said they would. Next, I asked whether if the pharmacogenomic information were already available in the medical record, would they use it?
Over 90% said yes. Pre-emptive pharmacogenomic testing is already being carried out in medical centers across the US, like at the Mayo Clinic, where a study of their patients found that 99% carried at least one actionable pharmacogenomic variant among the five pharmacogenes tested. Imagine the value of an ID card that you carry around, like this prototype designed by the European Union's U-PGx program that has important information about how drugs can be best tailored to your specific genetic makeup.
For more information about pharmacogenomic testing, check out our new book from McGraw-Hill Education entitled Precision Medicine A Guide to Genomics in Clinical Practice.
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