by brant bullard | Mar 16, 2014 | Journal articles
Pharmacogenetic (PGx) testing is a type of genetic test that assesses a patient’s risk of an adverse response or likelihood to respond to a given drug, informing drug selection and dosing.
As a pillar of the personalized medicine movement, PGx testing is anticipated to be important across all medical specialties,2 but particularly in primary care, where the majority of all drug prescriptions are written. It has been estimated that many of the drugs commonly prescribed by primary care practitioners (PCPs) such as fluoxetine, metoprolol, warfarin, and simvastatin are affected by PGx variation. Although several different strategies of delivering PGx testing have been proposed or are being investigated,6–8 at present, there is little clarity on which health professionals should order PGx testing, at what stage during treatment testing should be ordered, how best to communicate results to patients, and where results should be stored to inform future therapeutic decision making. Patients prefer receiving PGx test results from a familiar provider whom they trust such as a PCP; however, several factors have contributed to the slow integration of PGx testing in the primary care setting, including limited time as well as familiarity and experience with PGx testing. Because PGx testing is a relatively new field and many PCPs are unfamiliar with many of the basic tenets of the field, ongoing learning opportunities and/or faculty development would enable PCPs to feel more comfortable with the topic, and presumably engage in more effective communication with patients, and more appropriate use of testing. This paper suggests key elements to be discussed with patients prior to testing and when reporting test results to assist PCPs while recognizing some of the practical limitations in the primary care setting.
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by brant bullard | Mar 10, 2014 | Journal articles, News
With the increasing need for personalized medicine, pharmacists are beginning to embrace pharmacogenetics. And with continued education, they will have the capacity to improve patients’ lives.
The age of pharmacogenetics has arrived. Pharmacists are taking notice and using this information to help determine which patients require specific treatments, to guide dosage selection, and to predict how patients will respond to therapy.
“After decades of research, pharmacogenetics is moving from research into routine clinical practice,” said James Hoffman, PharmD, MS, BCPS, medication outcomes and safety officer at St. Jude Children’s Research Hospital in Memphis, Tennessee. “Pharmacists can help lead the way.”
Dr. Hoffman spoke about how pharmacists can better harness the power of pharmacogenetics at the American Pharmacists Association Annual Meeting and Exposition in Los Angeles, California.
He pointed out that more than 100 drug labels now provide pharmacogenetic information, and the US Food and Drug Administration uses genetic information in safety warnings, such as the recent boxed warning for codeine use in children.
Genetic tests are not being used as much as they could be to help decide on drugs and doses, Dr. Hoffman explained. However, the fact that we can now “genotype 225 genes relevant to drug metabolism for the cost of 1 or 2 single gene tests” will likely lead to increased use, he noted.
The first step to increasing pharmacist involvement in pharmacogenetics is to reduce existing knowledge gaps. “There is a need for more active learning experiences, such as continuing education and continuing professional development, to demonstrate the utility of pharmacogenetic principles in a variety of disciplines,” she said. “It was not surprising to discover in my preliminary results that only 9% of respondents had completed any continuing education related to pharmacogenetics.” Pharmacists who want to be more involved, and even those who are unsure, need to actively seek out educational experiences.
Pharmacists with access to pharmacogenetic information should use it when recommending changes to a patient’s drug therapy. “Many community pharmacists were able to identify the appropriate tests required for various drugs, but the majority struggled with modifying drug regimens when provided with pharmacogenetic data,” Dr. Ammons explained. Increased documentation is essential to provide pharmacists and other healthcare providers with a foundation for the application of such information.
Both Dr. Ammons and Dr. Hoffman point out that education and collaboration are critical to getting pharmacists involved in pharmacogenetics. With more knowledge, they will have the capacity to improve patients’ lives.
Read entire article at Medscape.com
by brant bullard | Dec 27, 2013 | Journal articles, News
Excerpt: Many studies from around the world show a correlation between increasing age and adverse drug reaction (ADR) rate, at least for some medical conditions. More than 80% of ADRs causing admission or occurring in hospital are type A (dose-related) in nature, and thus predictable from the known pharmacology of the drug and therefore potentially avoidable. Frail elderly patients appear to be particularly at risk of ADRs and this group is also likely to be receiving several medicines. The toxicity of some drug combinations may sometimes be synergistic and be greater than the sum of the risks of toxicity of either agent used alone. In order to recognize and to prevent ADRs (including drug interactions), good communication is crucial, and prescribers should develop an effective therapeutic partnership with the patient and with fellow health professionals.
Citation: Br J Clin Pharmacol. 2004 February; 57(2): 121–126.
doi: 10.1046/j.1365-2125.2003.01875.x
P A Routledge, M S O’Mahony,1 and K W Woodhouse1
Access full white paper here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884428/
by brant bullard | Dec 27, 2013 | Journal articles, News
Excerpt: “Genetic variability can also be useful in understanding ineffective or unsafe prescriptions. In US alone, >3 billion prescriptions are written annually and millions of people depend on prescription and over the counter drugs to sustain their health. It has been estimated that >3 million of those prescriptions are either incorrect or ineffective. A non-efficacious drug decreases chances of survival while increasing additional cost to the patient. Deaths due to adverse drug reactions (ADRs) rank 4th-6th leading cause of deaths in US [8]. The cost associated with ADRs is expected to be >177 billion annually. Pharmacogenomics has the potential to minimize ADRs and some of the ADRs previously considered unpreventable may now be preventable due to better understanding of genetic variability [9–12]. These postmarketing experiences support the idea that pharmacogenetics should be involved early on in the drug development process and these postmarketing lessons are very beneficial in predicting clinical outcomes to a much better extent.”
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Citation: Gupta D (2013) Pharmacogenomics in Drug Discovery and Development. J Develop Drugs 2:e126. doi: 10.4172/2329-6631.1000e126
by brant bullard | Oct 27, 2013 | Journal articles, News
Excerpt: Poor medication adherence is a well-known problem, particularly in patients with chronic conditions, and is associated with significant morbidity, mortality and health-care costs. Multi-faceted and personalized interventions have shown the greatest success. Pharmacogenetic (PGx) testing may serve as another tool to boost patients’ confidence in the safety and efficacy of prescribed medications. Here, we consider the potential impact (positively or negatively) of PGx testing on medication-taking behavior.
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Citation: S B Haga and N M A LaPointeThe Pharmacogenomics Journal (2013) 13, 481–483; doi:10.1038/tpj.2013.33; published online 3 September 2013
