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Lteif C, Eddy E, Terrell J, Cavallari LH, Malaty J, Duarte JD. Feasibility of preemptive pharmacogenetic testing and improvement of medication treatment satisfaction among medically underserved patients. Clin Transl Sci 2024; 17:e13692. [PMID: 38013396 PMCID: PMC10772669 DOI: 10.1111/cts.13692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
Previous findings suggest that medically underserved patients are prescribed medications with pharmacogenetic (PGx) guidelines at a high frequency. Thus, underserved patients may especially benefit from PGx testing, but little evidence exists regarding the effect of testing in this population. This pilot study aimed to generate key feasibility data and explore clinical outcomes of PGx implementation in underserved populations. Black and Latino patients were recruited from an outpatient clinic and underwent PGx testing. Feasibility measures included enrollment metrics and actionable genotype frequencies. The primary clinical outcome was patient medication treatment satisfaction 6 months after testing. Implementation outcomes included the number of healthcare provider encounters and medication changes within the 6-month follow-up. Effectiveness outcomes included medication adherence, patient-perceived test value, and time spent discussing medications with providers. Ninety-nine patients completed the study. Proton-pump inhibitors were the most frequent PGx drug class prescribed at baseline (61%) followed by nonsteroidal anti-inflammatory drugs (36%). Patients with an actionable genotype constituted 96% of the population, whereas 28% had an actionable genotype related to their PGx drug. Patient treatment satisfaction significantly increased over the 6 months after PGx testing. In addition, medication adherence and the number of provider encounters significantly increased over the study period. In a pilot study, preemptive PGx testing was feasible in primary care clinics, improved patient treatment satisfaction and adherence, and increased the number of provider encounters in medically underserved patients. Future clinical trials are warranted to assess the long-term effects of PGx testing in a larger diverse patient population.
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Affiliation(s)
- Christelle Lteif
- Center for Pharmacogenomics and Precision Medicine and Department of Pharmacotherapy and Translational Research, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Elizabeth Eddy
- Center for Pharmacogenomics and Precision Medicine and Department of Pharmacotherapy and Translational Research, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Joshua Terrell
- Center for Pharmacogenomics and Precision Medicine and Department of Pharmacotherapy and Translational Research, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - Larisa H. Cavallari
- Center for Pharmacogenomics and Precision Medicine and Department of Pharmacotherapy and Translational Research, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
| | - John Malaty
- Department of Community Health and Family Medicine, College of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Julio D. Duarte
- Center for Pharmacogenomics and Precision Medicine and Department of Pharmacotherapy and Translational Research, College of PharmacyUniversity of FloridaGainesvilleFloridaUSA
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2
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Murry LT, Hillman LA, Allen JD, Bishop JR. Intersection and Considerations for Patient-Centered Care, Patient Experience, and Medication Experience in Pharmacogenomics. PHARMACY 2023; 11:146. [PMID: 37736918 PMCID: PMC10514786 DOI: 10.3390/pharmacy11050146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/25/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023] Open
Abstract
As healthcare continues to embrace the concept of person- and patient-centered care, pharmacogenomics, patient experience, and medication experience will continue to play an increasingly important role in care delivery. This review highlights the intersection between these concepts and provides considerations for patient-centered medication and pharmacogenomic experiences. Elements at the patient, provider, and system level can be considered in the discussion, supporting the use of pharmacogenomics, with components of the patient and medication experience contributing to the mitigation of barriers surrounding patient use and the valuation of pharmacogenomic testing.
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Affiliation(s)
- Logan T. Murry
- College of Pharmacy, The University of Iowa, Iowa City, IA 52242, USA
| | - Lisa A. Hillman
- College of Pharmacy, The University of Minnesota, Minneapolis, MN 55455, USA; (L.A.H.); or (J.D.A.); (J.R.B.)
| | - Josiah D. Allen
- College of Pharmacy, The University of Minnesota, Minneapolis, MN 55455, USA; (L.A.H.); or (J.D.A.); (J.R.B.)
- Department of Pharmacy, St. Elizabeth Healthcare, Edgewood, KY 41017, USA
| | - Jeffrey R. Bishop
- College of Pharmacy, The University of Minnesota, Minneapolis, MN 55455, USA; (L.A.H.); or (J.D.A.); (J.R.B.)
- Medical School, The University of Minnesota, Minneapolis, MN 55455, USA
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3
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Hindi NN, Alenbawi J, Nemer G. Pharmacogenomics Variability of Lipid-Lowering Therapies in Familial Hypercholesterolemia. J Pers Med 2021; 11:jpm11090877. [PMID: 34575654 PMCID: PMC8468752 DOI: 10.3390/jpm11090877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 01/10/2023] Open
Abstract
The exponential expansion of genomic data coupled with the lack of appropriate clinical categorization of the variants is posing a major challenge to conventional medications for many common and rare diseases. To narrow this gap and achieve the goals of personalized medicine, a collaborative effort should be made to characterize the genomic variants functionally and clinically with a massive global genomic sequencing of "healthy" subjects from several ethnicities. Familial-based clustered diseases with homogenous genetic backgrounds are amongst the most beneficial tools to help address this challenge. This review will discuss the diagnosis, management, and clinical monitoring of familial hypercholesterolemia patients from a wide angle to cover both the genetic mutations underlying the phenotype, and the pharmacogenomic traits unveiled by the conventional and novel therapeutic approaches. Achieving a drug-related interactive genomic map will potentially benefit populations at risk across the globe who suffer from dyslipidemia.
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Affiliation(s)
- Nagham N. Hindi
- Division of Genomics and Translational Biomedicine, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha P.O. Box 34110, Qatar; (N.N.H.); (J.A.)
| | - Jamil Alenbawi
- Division of Genomics and Translational Biomedicine, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha P.O. Box 34110, Qatar; (N.N.H.); (J.A.)
| | - Georges Nemer
- Division of Genomics and Translational Biomedicine, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha P.O. Box 34110, Qatar; (N.N.H.); (J.A.)
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut DTS-434, Lebanon
- Correspondence: ; Tel.: +974-445-41330
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4
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Haga SB, Mills R, Moaddeb J, Liu Y, Voora D. Delivery of Pharmacogenetic Testing with or without Medication Therapy Management in a Community Pharmacy Setting. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:785-796. [PMID: 34276225 PMCID: PMC8277445 DOI: 10.2147/pgpm.s314961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
Objective The delivery of pharmacogenetic (PGx) testing has primarily been through clinical and hospital settings. We conducted a study to explore the feasibility of delivering PGx testing through community pharmacies, a less-studied setting. Methods We conducted a cluster randomized trial of community pharmacies in North Carolina through two approaches: the provision of PGx testing alone or PGx testing with medication therapy management (MTM). Results A total of 150 patient participants were enrolled at 17 pharmacies and reported high satisfaction with their testing experience. Participants in the PGx plus MTM arm were more likely to recall a higher number of results (p=0.04) and more likely to clearly understand their choices for prevention or early detection of side effects (p=0.01). A medication or dose change based on the PGx results was made for 8.7% of participants. Conclusion Limited differences were observed in the provision of PGx testing as a standalone test or combined with MTM. A limited number of treatment changes were made based on PGx test results. Patient acceptance of PGx testing offered through the community pharmacy was very high, but the addition of MTM did not impact patient-reported perceptions about PGx testing or medication adherence.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
| | - Rachel Mills
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
| | - Jivan Moaddeb
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
| | - Yiling Liu
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
| | - Deepak Voora
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA
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5
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Christian C, Borden BA, Danahey K, Yeo KTJ, van Wijk XM, Ratain MJ, O’Donnell PH. Pharmacogenomic-Based Decision Support to Predict Adherence to Medications. Clin Pharmacol Ther 2020; 108:368-376. [PMID: 32236960 PMCID: PMC7363565 DOI: 10.1002/cpt.1838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 03/13/2020] [Indexed: 02/03/2023]
Abstract
Poor adherence is associated with worse disease outcomes. Pharmacogenomics provides a possible intervention to address adherence. We hypothesized that pharmacogenomic-informed care could increase adherence. Patients in a prospective case-control study underwent preemptive pharmacogenomic genotyping with results available for provider use at the point of care; controls (not genotyped) were treated by the same providers. Over 6,000 e-prescriptions for 39 medications with actionable pharmacogenomic information were analyzed. Composite adherence, measured by modified proportion of days covered (mPDC), was compared between cases/controls and genomically concordant vs. genomically higher-risk medications. Overall, 536 patients were included. No difference in mean mPDC was observed due to availability of pharmacogenomic guidance. However, case patients prescribed high-risk pharmacogenomic medications were more than twice as likely to have low mPDC for these medications compared with genomically concordant prescriptions (odds ratio = 2.4 (1.03-5.74), P < 0.05). This study is the first to show that composite pharmacogenomic information predicts adherence.
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Affiliation(s)
- Carlton Christian
- The University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
| | - Brittany A. Borden
- The University of Chicago Center for Personalized Therapeutics, Chicago, IL, USA
| | - Keith Danahey
- The University of Chicago Center for Personalized Therapeutics, Chicago, IL, USA
- The University of Chicago Center for Research Informatics, Chicago, IL, USA
| | - Kiang-Teck J. Yeo
- The University of Chicago Center for Personalized Therapeutics, Chicago, IL, USA
- The University of Chicago Department of Pathology, Chicago, IL, USA
- UChicago Advanced Technology Clinical Laboratory, Chicago, IL, USA
- The University of Chicago Committee on Clinical Pharmacology and Pharmacogenomics, Chicago, IL, USA
| | - Xander M.R. van Wijk
- The University of Chicago Department of Pathology, Chicago, IL, USA
- UChicago Advanced Technology Clinical Laboratory, Chicago, IL, USA
| | - Mark J. Ratain
- The University of Chicago Center for Personalized Therapeutics, Chicago, IL, USA
- The University of Chicago Committee on Clinical Pharmacology and Pharmacogenomics, Chicago, IL, USA
- The University of Chicago Department of Medicine, Chicago, IL, USA
| | - Peter H. O’Donnell
- The University of Chicago Center for Personalized Therapeutics, Chicago, IL, USA
- The University of Chicago Committee on Clinical Pharmacology and Pharmacogenomics, Chicago, IL, USA
- The University of Chicago Department of Medicine, Chicago, IL, USA
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6
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Pharmacogenomic (PGx) Counseling: Exploring Participant Questions about PGx Test Results. J Pers Med 2020; 10:jpm10020029. [PMID: 32340147 PMCID: PMC7354504 DOI: 10.3390/jpm10020029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 12/17/2022] Open
Abstract
As pharmacogenomic (PGx) use in healthcare increases, a better understanding of patient needs will be necessary to guide PGx result delivery. The Coriell Personalized Medicine Collaborative (CPMC) is a prospective study investigating the utility of personalized medicine. Participants received online genetic risk reports for 27 potentially actionable complex diseases and 7 drug–gene pairs and could request free, telephone-based genetic counseling (GC). To explore the needs of individuals receiving PGx results, we conducted a retrospective qualitative review of inquiries from CPMC participants who requested counseling from March 2009 to February 2017. Eighty out of 690 (12%) total GC inquiries were focused on the discussion of PGx results, and six salient themes emerged: “general help”, “issues with drugs”, “relevant disease experience”, “what do I do now?”, “sharing results”, and “other drugs”. The number of reported medications with a corresponding PGx result and participant engagement were significantly associated with PGx GC requests (p < 0.01 and p < 0.02, respectively). Our work illustrates a range of questions raised by study participants receiving PGx test results, most of which were addressed by a genetic counselor with few requiring referrals to prescribing providers or pharmacists. These results further support a role for genetic counselors in the team-based approach to optimal PGx result delivery.
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7
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Weitzel KW, Duong BQ, Arwood MJ, Owusu-Obeng A, Abul-Husn NS, Bernhardt BA, Decker B, Denny JC, Dietrich E, Gums J, Madden EB, Pollin TI, Wu RR, Haga SB, Horowitz CR. A stepwise approach to implementing pharmacogenetic testing in the primary care setting. Pharmacogenomics 2019; 20:1103-1112. [PMID: 31588877 PMCID: PMC6854439 DOI: 10.2217/pgs-2019-0053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/29/2019] [Indexed: 01/12/2023] Open
Abstract
Pharmacogenetic testing can help identify primary care patients at increased risk for medication toxicity, poor response or treatment failure and inform drug therapy. While testing availability is increasing, providers are unprepared to routinely use pharmacogenetic testing for clinical decision-making. Practice-based resources are needed to overcome implementation barriers for pharmacogenetic testing in primary care.The NHGRI's IGNITE I Network (Implementing GeNomics In pracTicE; www.ignite-genomics.org) explored practice models, challenges and implementation barriers for clinical pharmacogenomics. Based on these experiences, we present a stepwise approach pharmacogenetic testing in primary care: patient identification; pharmacogenetic test ordering; interpretation and application of test results, and patient education. We present clinical factors to consider, test-ordering processes and resources, and provide guidance to apply test results and counsel patients. Practice-based resources such as this stepwise approach to clinical decision-making are important resources to equip primary care providers to use pharmacogenetic testing.
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Affiliation(s)
- Kristin Wiisanen Weitzel
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Benjamin Q Duong
- Department of Pharmacy, Nemours/Alfred I DuPont Hospital for Children, Wilmington, DE 19803, USA
| | - Meghan J Arwood
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Aniwaa Owusu-Obeng
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Noura S Abul-Husn
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Barbara A Bernhardt
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brian Decker
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Joshua C Denny
- Department of Medicine & Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Eric Dietrich
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - John Gums
- Department of Pharmacotherapy & Translational Research, University of Florida, Gainesville, FL 32608, USA
| | - Ebony B Madden
- National Human Genome Research Institute, Division of Genomic Medicine, Bethesda, MD 20892, USA
| | - Toni I Pollin
- Department of Medicine & Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Rebekah Ryanne Wu
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA
| | - Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA
| | - Carol R Horowitz
- Department of Health Policy & Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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8
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Streja E, Streja DA, Soohoo M, Kleine CE, Hsiung JT, Park C, Moradi H. Precision Medicine and Personalized Management of Lipoprotein and Lipid Disorders in Chronic and End-Stage Kidney Disease. Semin Nephrol 2019; 38:369-382. [PMID: 30082057 DOI: 10.1016/j.semnephrol.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Precision medicine is an emerging field that calls for individualization of treatment strategies based on characteristics unique to each patient. In lipid management, current guidelines are driven mainly by clinical trial results that presently indicate that patients with non-dialysis-dependent chronic kidney disease (CKD) should be treated with a β-hydroxy β-methylglutaryl-CoA reductase inhibitor, also known as statin therapy. For patients with end-stage kidney disease (ESKD) being treated with hemodialysis, statin therapy has not been shown to successfully reduce poor outcomes in trials and therefore is not recommended. The two major guidelines dissent on whether statin therapy should be of moderate or high intensity in non-dialysis-dependent CKD patients, but often leave the prescribing clinician to make that decision. These decisions often are complicated by the increased concerns for adverse events such as myopathies in patients with advanced kidney disease and ESKD. In the future, there may be an opportunity to further identify CKD and ESKD patients who are more likely to benefit from lipid-modifying therapy as opposed to those who likely will suffer from its side effects using precision medicine tools. For now, data from genetics studies and subgroup analyses may provide insight for future research directions in this field and we review some of the work that has been published in this regard.
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Affiliation(s)
- Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA.; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA..
| | - Dan A Streja
- Division of Endocrinology, Diabetes and Metabolism, West Los Angeles VA Medical Center, Greater Los Angeles VA Healthcare System, Los Angeles, CA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA.; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
| | - Carola-Ellen Kleine
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA.; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
| | - Jui-Ting Hsiung
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA.; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
| | - Christina Park
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA.; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
| | - Hamid Moradi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA.; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA
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9
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Borden BA, Lee SM, Danahey K, Galecki P, Patrick-Miller L, Siegler M, Sorrentino MJ, Sacro Y, Davis AM, Rubin DT, Lipstreuer K, Polonsky TS, Nanda R, Harper WR, Koyner JL, Burnet DL, Stadler WM, Kavitt RT, Meltzer DO, Ratain MJ, O'Donnell PH. Patient-provider communications about pharmacogenomic results increase patient recall of medication changes. THE PHARMACOGENOMICS JOURNAL 2019; 19:528-537. [PMID: 30713337 PMCID: PMC6980369 DOI: 10.1038/s41397-019-0076-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 10/12/2018] [Accepted: 12/21/2018] [Indexed: 01/21/2023]
Abstract
Effective doctor-patient communication is critical for disease management, especially when considering genetic information. We studied patient-provider communications after implementing a point-of-care pharmacogenomic results delivery system to understand whether pharmacogenomic results are discussed and whether medication recall is impacted. Outpatients undergoing preemptive pharmacogenomic testing (cases), non-genotyped controls, and study providers were surveyed from October 2012-May 2017. Patient responses were compared between visits where pharmacogenomic results guided prescribing versus visits where pharmacogenomics did not guide prescribing. Provider knowledge of pharmacogenomics, before and during study participation, was also analyzed. Both providers and case patients frequently reported discussions of genetic results after visits where pharmacogenomic information guided prescribing. Importantly, medication changes from visits where pharmacogenomics influenced prescribing were more often recalled than non-pharmacogenomic guided medication changes (OR=3.3 [1.6–6.7], p=0.001). Case patients who had separate visits where pharmacogenomics did and did not respectively influence prescribing more often remembered medication changes from visits where genomic-based guidance was used (OR=3.4 [1.2–9.3], p=0.02). Providers also displayed dramatic increases in personal genomic understanding through program participation (94% felt at least somewhat informed about pharmacogenomics post-participation, compared to 61% at baseline, p=0.04). Using genomic information during prescribing increases patient-provider communications, patient medication recall, and provider understanding of genomics, important ancillary benefits to clinical use of pharmacogenomics.
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Affiliation(s)
- Brittany A Borden
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA
| | - Sang Mee Lee
- Department of Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Keith Danahey
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Center for Research Informatics, The University of Chicago, Chicago, IL, USA
| | - Paige Galecki
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA
| | | | - Mark Siegler
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA.,MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA.,Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, IL, USA
| | - Matthew J Sorrentino
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Yasmin Sacro
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA.,University of Colorado/Denver Health, Denver, CO, USA
| | - Andrew M Davis
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - David T Rubin
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Kristen Lipstreuer
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Tamar S Polonsky
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Rita Nanda
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - William R Harper
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA.,Northwestern University, Chicago, IL, USA
| | - Jay L Koyner
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Deborah L Burnet
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Walter M Stadler
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Robert T Kavitt
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - David O Meltzer
- Department of Medicine, The University of Chicago, Chicago, IL, USA.,The Center for Health and the Social Sciences, The University of Chicago, Chicago, IL, USA
| | - Mark J Ratain
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA.,Department of Medicine, The University of Chicago, Chicago, IL, USA.,Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, IL, USA
| | - Peter H O'Donnell
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA. .,Department of Medicine, The University of Chicago, Chicago, IL, USA. .,Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, IL, USA.
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10
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Peyser B, Perry EP, Singh K, Gill RD, Mehan MR, Haga SB, Musty MD, Milazzo NA, Savard D, Li YJ, Trujilio G, Voora D. Effects of Delivering
SLCO1B1
Pharmacogenetic Information in Randomized Trial and Observational Settings. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2018; 11:e002228. [DOI: 10.1161/circgen.118.002228] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bruce Peyser
- Department of Medicine (B.P., K.S., G.T., D.V.), Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC. United States (S.B.H., M.D.M., D.V.)
| | | | - Kavisha Singh
- Department of Medicine (B.P., K.S., G.T., D.V.), Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC. United States (S.B.H., M.D.M., D.V.)
| | | | | | - Susanne B. Haga
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC. United States (E.P.P., Y.-J.L.)
| | - Michael D. Musty
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC. United States (E.P.P., Y.-J.L.)
| | | | | | - Yi-Ju Li
- Air Force, Fairfield, CA (N.A.M., D.S.)
| | - Gloria Trujilio
- Department of Medicine (B.P., K.S., G.T., D.V.), Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC. United States (S.B.H., M.D.M., D.V.)
| | - Deepak Voora
- Department of Medicine (B.P., K.S., G.T., D.V.), Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC. United States (S.B.H., M.D.M., D.V.)
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC. United States (E.P.P., Y.-J.L.)
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11
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Personalized rosuvastatin therapy in problem patients with partial statin intolerance. ACTA ACUST UNITED AC 2018; 3:e83-e89. [PMID: 30775595 PMCID: PMC6374586 DOI: 10.5114/amsad.2018.76826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 04/22/2018] [Indexed: 12/28/2022]
Abstract
Introduction The aim was to study the pharmacogenetic determinants of switching simvastatin-intolerant ethnic Uzbek patients with coronary artery disease (CAD) to rosuvastatin treatment. Material and methods The study included 50 patients with CAD, who demonstrated statin-induced adverse liver symptoms, accompanied by an elevation in transaminase level (3-fold or more in 37 cases) or statin-induced adverse muscle symptoms, accompanied by elevations in serum (CK > 3 times above the upper limit of normal (ULN)) in simvastatin treatment with a dose of 10-20 mg/day. The control group consisted of 50 patients without side effects. Patients were genotyped for polymorphisms in the genes coding for the cytochrome P450 (CYP) metabolic enzymes CYP3A5(6986A>G), CYP2C9(430C>T), CYP2C9(1075A>C), and hepatic influx and efflux transporters SLCO1B1(521T>C) and BCRP(ABCG2, 421C>A) by means of the PCR-RFLP method. Results When the 50 patients of the case group were switched to the starting rosuvastatin dose of 5 mg, intolerance symptoms were not observed in 29 (58%) versus 21 with adverse symptoms. In this case-control study, the groups differed significantly only in the prevalence of the *3/*3 genotype CYP3A5 (OR = 5.25; 95% CI: 1.6-17.8; p = 0.014). Conclusions In a considerable proportion of ethnic Uzbek patients with CAD and simvastatin intolerance symptoms, serious side effects when switching to a starting dose of rosuvastatin were not observed, and it should be noted that in most cases (72.4%) this phenomenon was observed among the carriers of *3/*3 genotype of the CYP3A5 (6986A> G) gene.
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Affiliation(s)
- Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
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13
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Angelini S, Rosticci M, Massimo G, Musti M, Ravegnini G, Consolini N, Sammarini G, D'Addato S, Rizzoli E, Botbayev D, Borghi C, Cantelli-Forti G, Cicero AF, Hrelia P. Relationship between Lipid Phenotypes, Overweight, Lipid Lowering Drug Response and KIF6 and HMG-CoA Genotypes in a Subset of the Brisighella Heart Study Population. Int J Mol Sci 2017; 19:ijms19010049. [PMID: 29295555 PMCID: PMC5795999 DOI: 10.3390/ijms19010049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 01/14/2023] Open
Abstract
The existence of genetic traits might explain the susceptibility to develop hypercholesterolemia and the inter-individual differences in statin response. This study was performed to evaluate whether individuals' polymorphisms in HMG-CoA and KIF6 genes are independently associated with hypercholesterolemia, other lipid-associated traits, and statin response in unselected individuals enrolled in the Brisighella heart study (Survey 2012). A total of 1622 individuals, of which 183 under statin medication, were genotyped for a total of five polymorphisms (KIF6 rs20455, rs9471077, rs9462535; HMG-CoA rs3761740, rs3846662). The relationships between the five loci and clinical characteristics were analyzed. The principal basic parameters calculated on 12 h fasting blood included total cholesterol (TC), High Density Lipoprotein Cholesterol (HDL-C), Low-Density Lipoprotein Cholesterol (LDL-C), and triglycerides (TG). Hypercholesterolemia was defined as a TC >200 mg/dL or use of lipid-lowering medication. 965 individuals were characterized by hypercholesterolemia; these subjects were significantly older (p < 0.001), with body mass index (BMI) and waist circumference significantly higher (p < 0.001) compared to the others. HMG-CoA rs3846662 GG genotype was significantly over-represented in the hypercholesterolemic group (p = 0.030). HMG-CoA rs3846662 genotype was associated with the level of TC and LDL-C. Furthermore, in the same subset of untreated subjects, we observed a significant correlation between the KIF6 rs20455 and HDL-C. KIF6 variants were associated with a significantly lower (rs20455) or higher (rs9471077 and rs9462535) risk of obesity, in males only. No association between responsiveness to statins and the polymorphisms under investigation were observed. Our results showed associations between HMG-CoA rs3846662 and KIF6 rs20455 and lipid phenotypes, which may have an influence on dyslipidemia-related events. Moreover, this represents the first study implicating KIF6 variants with obesity in men, and point to the possible involvement of this genetic locus in the known gender-related differences in coronary artery disease.
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Affiliation(s)
- Sabrina Angelini
- Department of Pharmacy and Biotechnology, via Irnerio 48, University of Bologna, 40126 Bologna, Italy.
| | - Martina Rosticci
- Department of Medical and Surgical, University of Bologna, 40126 Bologna, Italy.
| | - Gianmichele Massimo
- Department of Pharmacy and Biotechnology, via Irnerio 48, University of Bologna, 40126 Bologna, Italy.
- Department of Medical and Surgical, University of Bologna, 40126 Bologna, Italy.
| | - Muriel Musti
- Department of Public Health, Epidemiological Service, Local Health Authority of Bologna, 40126 Bologna, Italy.
| | - Gloria Ravegnini
- Department of Pharmacy and Biotechnology, via Irnerio 48, University of Bologna, 40126 Bologna, Italy.
| | - Nicola Consolini
- Department of Pharmacy and Biotechnology, via Irnerio 48, University of Bologna, 40126 Bologna, Italy.
| | - Giulia Sammarini
- Department of Pharmacy and Biotechnology, via Irnerio 48, University of Bologna, 40126 Bologna, Italy.
| | - Sergio D'Addato
- Department of Medical and Surgical, University of Bologna, 40126 Bologna, Italy.
| | - Elisabetta Rizzoli
- Department of Medical and Surgical, University of Bologna, 40126 Bologna, Italy.
| | - Dauren Botbayev
- Department of Pharmacy and Biotechnology, via Irnerio 48, University of Bologna, 40126 Bologna, Italy.
- Department of Biotechnology, Faculty of Biology and Biotechnology, Кazakh National University Named after al-Farabi, 050040 Almaty, Kazakhstan.
| | - Claudio Borghi
- Department of Medical and Surgical, University of Bologna, 40126 Bologna, Italy.
| | - Giorgio Cantelli-Forti
- Department for Life Quality Studies, Corso d'Augusto 237, University of Bologna, 47921 Rimini, Italy.
| | - Arrigo F Cicero
- Department of Medical and Surgical, University of Bologna, 40126 Bologna, Italy.
| | - Patrizia Hrelia
- Department of Pharmacy and Biotechnology, via Irnerio 48, University of Bologna, 40126 Bologna, Italy.
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Haga SB. Integrating pharmacogenetic testing into primary care. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017; 2:327-336. [PMID: 31853504 DOI: 10.1080/23808993.2017.1398046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction Pharmacogenetic (PGx) testing has greatly expanded due to enhanced understanding of the role of genes in drug response and advances in DNA-based testing technology development. As many primary care visits result in a prescription, the use of PGx testing may be particularly beneficial in this setting. However, integration of PGx testing may be limited as no uniform approach to delivery of tests has been established and providers are ill-prepared to integrate PGx testing into routine care. Areas covered In this paper, the readiness of primary care practitioners are reviewed as well as strategies to address these barriers based on published research and ongoing activities on education and implementation of PGx testing. Expert Commentary Widespread integration of PGx testing will warrant continued education and point-of-care decisional support. Primary care providers may also benefit from consultation services or team-based care with laboratory medicine specialists, pharmacists, and genetic counselors.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Durham, NC 27708, USA,
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Heale BSE, Khalifa A, Stone BL, Nelson S, Del Fiol G. Physicians' pharmacogenomics information needs and seeking behavior: a study with case vignettes. BMC Med Inform Decis Mak 2017; 17:113. [PMID: 28764766 PMCID: PMC5540399 DOI: 10.1186/s12911-017-0510-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background Genetic testing, especially in pharmacogenomics, can have a major impact on patient care. However, most physicians do not feel that they have sufficient knowledge to apply pharmacogenomics to patient care. Online information resources can help address this gap. We investigated physicians’ pharmacogenomics information needs and information-seeking behavior, in order to guide the design of pharmacogenomics information resources that effectively meet clinical information needs. Methods We performed a formative, mixed-method assessment of physicians’ information-seeking process in three pharmacogenomics case vignettes. Interactions of 6 physicians’ with online pharmacogenomics resources were recorded, transcribed, and analyzed for prominent themes. Quantitative data included information-seeking duration, page navigations, and number of searches entered. Results We found that participants searched an average of 8 min per case vignette, spent less than 30 s reviewing specific content, and rarely refined search terms. Participants’ information needs included a need for clinically meaningful descriptions of test interpretations, a molecular basis for the clinical effect of drug variation, information on the logistics of carrying out a genetic test (including questions related to cost, availability, test turn-around time, insurance coverage, and accessibility of expert support).Also, participants sought alternative therapies that would not require genetic testing. Conclusion This study of pharmacogenomics information-seeking behavior indicates that content to support their information needs is dispersed and hard to find. Our results reveal a set of themes that information resources can use to help physicians find and apply pharmacogenomics information to the care of their patients. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0510-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bret S E Heale
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Salt Lake City, UT, 84108, USA.,Intermountain Healthcare, West Valley, UT, USA
| | - Aly Khalifa
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Bryan L Stone
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Scott Nelson
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Salt Lake City, UT, 84108, USA.
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Abstract
OBJECTIVE We investigated the association between clinical outcome and the recommendations of a pharmacogenetic test (Neuropharmagen) in patients with a variety of psychiatric conditions whose previous treatment regimen had failed. METHODS This retrospective, naturalistic, multicenter study included adult psychiatric patients (depression, psychosis, anxiety, bipolar, etc.) who had been seen at 3 private clinics. All patients had received pharmacogenetic testing (Neuropharmagen) and were classified depending on whether or not their post-test treatment regimen followed the test recommendations. Clinical severity was assessed with the Clinical Global Impression of Severity (CGI-S) at baseline (pre-test) and 3-month follow-up, and adverse events were recorded. RESULTS 182 patients were available for analysis. After multivariate adjustment, patients whose treatment followed the test recommendations had odds of improvement about 4 times greater than patients whose treatment did not follow the recommendations (adjusted OR=3.86, 95%CI 1.36-10.95; p=0.011). Importantly, psychiatric diagnosis did not significantly affect the odds of improvement. Also, in the subpopulation with baseline CGI-S score >3 (N=170), the rate of stabilization at follow-up (defined as CGI-S≤3) was significantly higher in patients whose treatment followed the pharmacogenetic recommendations (p=0.033). There was no apparent difference in the incidence of adverse events (6 patients in each group). CONCLUSIONS Non-drug naïve patients whose treatment followed the recommendations of pharmacogenetic testing were more likely to improve their condition than patients whose treatment did not. These results are consistent with previous clinical research on depressed patients, and this study also suggests that this benefit can be extended to psychiatric conditions other than depression.
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Pérez V, Salavert A, Espadaler J, Tuson M, Saiz-Ruiz J, Sáez-Navarro C, Bobes J, Baca-García E, Vieta E, Olivares JM, Rodriguez-Jimenez R, Villagrán JM, Gascón J, Cañete-Crespillo J, Solé M, Saiz PA, Ibáñez Á, de Diego-Adeliño J, Menchón JM. Efficacy of prospective pharmacogenetic testing in the treatment of major depressive disorder: results of a randomized, double-blind clinical trial. BMC Psychiatry 2017; 17:250. [PMID: 28705252 PMCID: PMC5513031 DOI: 10.1186/s12888-017-1412-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/29/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A 12-week, double-blind, parallel, multi-center randomized controlled trial in 316 adult patients with major depressive disorder (MDD) was conducted to evaluate the effectiveness of pharmacogenetic (PGx) testing for drug therapy guidance. METHODS Patients with a CGI-S ≥ 4 and requiring antidepressant medication de novo or changes in their medication regime were recruited at 18 Spanish public hospitals, genotyped with a commercial PGx panel (Neuropharmagen®), and randomized to PGx-guided treatment (n = 155) or treatment as usual (TAU, control group, n = 161), using a computer-generated random list that locked or unlocked psychiatrist access to the results of the PGx panel depending on group allocation. The primary endpoint was the proportion of patients achieving a sustained response (Patient Global Impression of Improvement, PGI-I ≤ 2) within the 12-week follow-up. Patients and interviewers collecting the PGI-I ratings were blinded to group allocation. Between-group differences were evaluated using χ2-test or t-test, as per data type. RESULTS Two hundred eighty patients were available for analysis at the end of the 12-week follow-up (PGx n = 136, TAU n = 144). A difference in sustained response within the study period (primary outcome) was not observed (38.5% vs 34.4%, p = 0.4735; OR = 1.19 [95%CI 0.74-1.92]), but the PGx-guided treatment group had a higher responder rate compared to TAU at 12 weeks (47.8% vs 36.1%, p = 0.0476; OR = 1.62 [95%CI 1.00-2.61]), and this difference increased after removing subjects in the PGx-guided group when clinicians explicitly reported not to follow the test recommendations (51.3% vs 36.1%, p = 0.0135; OR = 1.86 [95%CI 1.13-3.05]). Effects were more consistent in patients with 1-3 failed drug trials. In subjects reporting side effects burden at baseline, odds of achieving a better tolerability (Frequency, Intensity and Burden of Side Effects Rating Burden subscore ≤2) were higher in the PGx-guided group than in controls at 6 weeks and maintained at 12 weeks (68.5% vs 51.4%, p = 0.0260; OR = 2.06 [95%CI 1.09-3.89]). CONCLUSIONS PGx-guided treatment resulted in significant improvement of MDD patient's response at 12 weeks, dependent on the number of previously failed medication trials, but not on sustained response during the study period. Burden of side effects was also significantly reduced. TRIAL REGISTRATION European Clinical Trials Database 2013-002228-18 , registration date September 16, 2013; ClinicalTrials.gov NCT02529462 , retrospectively registered: August 19, 2015.
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Affiliation(s)
- Víctor Pérez
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,grid.7080.fInstitut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Departament de Psiquiatria, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | - Jerónimo Saiz-Ruiz
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0000 9248 5770grid.411347.4Departament of Psychiatry, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Cristina Sáez-Navarro
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0001 2284 9230grid.410367.7University Psychiatric Hospital, Institut Pere Mata, IISPV, Universitat Rovira Virgili, Reus, Spain
| | - Julio Bobes
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0001 2164 6351grid.10863.3cÁrea de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Enrique Baca-García
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,grid.419651.eDepartamento de Psiquiatría, Fundación Jiménez Díaz, IIS FJD, Madrid, Spain ,0000000119578126grid.5515.4Hospital Universitario Rey Juan Carlos, Hospital Universitario Infanta Elena, Hospital General de Villalba, Universidad Autónoma de Madrid, Madrid, Spain ,0000000419368729grid.21729.3fColumbia University, New York, USA
| | - Eduard Vieta
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - José M. Olivares
- 0000 0004 1757 0405grid.411855.cDepartment of Psychiatry, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Instituto Biomédico Galicia Sur, Vigo, Spain
| | - Roberto Rodriguez-Jimenez
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0001 1945 5329grid.144756.5Department of Psychiatry, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - José M. Villagrán
- Psychiatric Hospitalization Unit, Hospital General de Jerez de la Frontera, Jerez de la Frontera, Cádiz Spain
| | - Josep Gascón
- 0000 0004 1794 4956grid.414875.bPsychiatric Unit, Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - Josep Cañete-Crespillo
- 0000 0004 1770 3861grid.466613.0Mental Health Department, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
| | - Montse Solé
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0001 2284 9230grid.410367.7University Psychiatric Hospital, Institut Pere Mata, IISPV, Universitat Rovira Virgili, Reus, Spain
| | - Pilar A. Saiz
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0001 2164 6351grid.10863.3cÁrea de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Oviedo, Spain
| | - Ángela Ibáñez
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,0000 0000 9248 5770grid.411347.4Departament of Psychiatry, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Javier de Diego-Adeliño
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,grid.7080.fServei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - José M. Menchón
- grid.469673.9Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Av. Monforte de Lemos, 3-5, Madrid, Spain ,Department of Psychiatry, Hospital Universitari de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Carretera de la Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Barcelona, Spain ,0000 0004 1937 0247grid.5841.8Departament de Ciències Clíniques, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
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Simoons M, Mulder H, Schoevers RA, Ruhé HG, van Roon EN. Availability of CYP2D6 genotyping results in general practitioner and community pharmacy medical records. Pharmacogenomics 2017; 18:843-851. [DOI: 10.2217/pgs-2017-0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate the availability of CYP450–2D6 (CYP2D6) genotyping results in general practitioner (GP) and/or community pharmacy records, and the influence thereof on psychotropic CYP2D6 substrate dosing. Materials & methods: Primary outcome was the percentage of patients genotyped for CYP2D6 with their genotype/phenotype registered in GP and/or pharmacy records. Secondary outcome was the number of defined daily doses of psychotropic CYP2D6 substrates prescribed after genotyping. Results: For 216 out of 1307 eligible patients, medication overviews could be obtained. Genotyping results were available at GPs for 3.1% and at pharmacies for 5.9%. The average psychotropic CYP2D6 substrate dose was not different between any non-extensive metabolizer group and extensive metabolizer group (all p ≥ 0.486). Conclusion: Valuable information for individualizing psychiatric pharmacotherapy is lost on a large scale.
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Affiliation(s)
- Mirjam Simoons
- Wilhelmina Hospital Assen, Department of Clinical Pharmacy, Assen, The Netherlands
- Department of Psychiatry, Interdisciplinary Center for Psychopathology & Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Pharmacy, Unit of Pharmacotherapy, –Epidemiology & –Economics, University of Groningen, Groningen, The Netherlands
| | - Hans Mulder
- Wilhelmina Hospital Assen, Department of Clinical Pharmacy, Assen, The Netherlands
- Psychiatric Hospital GGZ Drenthe, Assen, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, Interdisciplinary Center for Psychopathology & Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Interdisciplinary Center for Psychopathology & Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Eric N van Roon
- Department of Pharmacy, Unit of Pharmacotherapy, –Epidemiology & –Economics, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy & Clinical Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Lee YM, McKillip RP, Borden BA, Klammer CE, Ratain MJ, O’Donnell PH. Assessment of patient perceptions of genomic testing to inform pharmacogenomic implementation. Pharmacogenet Genomics 2017; 27:179-189. [PMID: 28267054 PMCID: PMC5478379 DOI: 10.1097/fpc.0000000000000275] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Pharmacogenomics seeks to improve prescribing by reducing drug inefficacy/toxicity. However, views of patients during pharmacogenomic-guided care are largely unknown. We sought to understand the attitudes and perceptions of patients in an institutional implementation project and hypothesized that views would differ on the basis of experience with pharmacogenomic-guided care. METHODS Two focus groups were conducted - one group included patients who had previously been subjected to broad pharmacogenomic genotyping with results available to physicians (pharmacogenomic group), whereas the other had not been offered genotyping (traditional care). Five domains were explored: (i) experiences with medications/side effects, (ii) understanding of pharmacogenomics, (iii) impact of pharmacogenomics on relationships with healthcare professionals, (iv) scenarios involving pharmacogenomic-guided prescribing, and (v) responses to pharmacogenomic education materials. RESULTS Nine pharmacogenomic and 13 traditional care participants were included. Participants in both groups agreed that pharmacogenomics could inform prescribing and help identify problem prescriptions, but expressed concerns over insurance coverage and employment discrimination. Both groups diverged on who should be permitted to access pharmacogenomic results, with some preferring access only for providers with a longstanding relationship, whereas others argued for open access. Notably, traditional care participants showed greater skepticism about how results might be used. Case scenarios and tested educational materials elicited strong desires on the part of patients for physicians to engage participants when considering pharmacogenomic-based prescribing and to utilize shared decision-making. CONCLUSION Participants experiencing pharmacogenomic-guided care were more receptive toward pharmacogenomic information being used than traditional care participants. As key stakeholders in implementation, addressing patients' concerns will be important to successfully facilitate clinical dissemination.
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Affiliation(s)
- Yee Ming Lee
- Center for Personalized Therapeutics, The University of Chicago, Chicago, USA
| | - Ryan P. McKillip
- The University of Chicago Pritzker School of Medicine, Chicago, USA
| | - Brittany A. Borden
- Center for Personalized Therapeutics, The University of Chicago, Chicago, USA
| | | | - Mark J. Ratain
- Center for Personalized Therapeutics, The University of Chicago, Chicago, USA
- Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, USA
- Department of Medicine, The University of Chicago, Chicago, USA
| | - Peter H. O’Donnell
- Center for Personalized Therapeutics, The University of Chicago, Chicago, USA
- Committee on Clinical Pharmacology and Pharmacogenomics, The University of Chicago, Chicago, USA
- Department of Medicine, The University of Chicago, Chicago, USA
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Remission in Pediatric Inflammatory Bowel Disease Correlates With Prescription Refill Adherence Rates. J Pediatr Gastroenterol Nutr 2017; 64:575-579. [PMID: 27299424 DOI: 10.1097/mpg.0000000000001304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of the study was to use pharmacy benefit management (PBM) prescription claims data to assess refill adherence in pediatric inflammatory bowel disease (IBD) and correlate adherence with clinical outcomes in pediatric IBD. METHODS We identified 362 pediatric patients with IBD seen at Washington University from 9/1/2012 to 8/31/2013 and matched them within Express Scripts' member eligibility files for clients allowing use of prescription drug data for research purposes. Maintenance IBD medication possession ratios (MPR) were determined through PBM prescription claims data and chart review. Demographic and prospectively captured physician global assessments (PGA) were retrospectively extracted from the medical record. MPR was analyzed as continuous data and also dichotomized as greater or less than 80%. RESULTS Among our 362 patients, we matched 228 (63%) within Express Scripts' eligibility data files. Of those, 78 patients were continuously eligible for benefits and had at least one outpatient prescription IBD medication prescribed. Their mean MPR was 0.63 ± 0.31 (standard deviation) and 40% had an MPR ≥80%. Patients in clinical remission had a higher mean MPR than those with an active PGA (0.72 ± 0.28 vs 0.51 ± 0.32, P = 0.002) and patients whose MPR were ≥80% were more likely to have a PGA of remission than those with whose MPR were <80% (84% vs 43%, P = <0.001). CONCLUSIONS We found a significant association between refill adherence and clinical remission. Nonadherence was common and was more common in adolescents. Use of PBM databases to identify and intervene on patients with poor adherence may improve outcomes in pediatric IBD.
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Jörntén-Karlsson M, Pintat S, Molloy-Bland M, Berg S, Ahlqvist M. Patient-Centered Interventions to Improve Adherence to Statins: A Narrative Synthesis of Systematically Identified Studies. Drugs 2017; 76:1447-1465. [PMID: 27677773 PMCID: PMC5047948 DOI: 10.1007/s40265-016-0640-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Poor adherence to statins increases cardiovascular disease risk. We systematically identified 32 controlled studies that assessed patient-centered interventions designed to improve statin adherence. The limited number of studies and variation in study characteristics precluded strict quality criteria or meta-analysis. Cognitive education or behavioural counselling delivered face-to-face multiple times consistently improved statin adherence compared with control groups (7/8 and 3/3 studies, respectively). None of four studies using medication reminders and/or adherence feedback alone reported significantly improved statin adherence. Single interventions that improved statin adherence but were not conducted face-to-face included cognitive education in the form of genetic test results (two studies) and cognitive education via a website (one study). Similar mean adherence measures were reported for 17 intervention arms and were thus compared in a sub-analysis: 8 showed significantly improved statin adherence, but effect sizes were modest (+7 to +22 % points). In three of these studies, statin adherence improved despite already being high in the control group (82-89 vs. 57-69 % in the other studies). These three studies were the only studies in this sub-analysis to include cognitive education delivered face-to-face multiple times (plus other interventions). In summary, the most consistently effective interventions for improving adherence to statins have modest effects and are resource-intensive. Research is needed to determine whether modern communications, particularly mobile health platforms (recently shown to improve medication adherence in other chronic diseases), can replicate or even enhance the successful elements of these interventions while using less time and fewer resources.
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Affiliation(s)
| | | | - Michael Molloy-Bland
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
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Friede K, Li J, Voora D. Use of Pharmacogenetic Information in the Treatment of Cardiovascular Disease. Clin Chem 2017; 63:177-185. [DOI: 10.1373/clinchem.2016.255232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/31/2016] [Indexed: 01/26/2023]
Abstract
Abstract
BACKGROUND
In 1964, Robert A. O'Reilly's research group identified members of a family who required remarkably high warfarin doses (up to 145 mg/day, 20 times the average dose) to achieve appropriate anticoagulation. Since this time, pharmacogenetics has become a mainstay of cardiovascular science, and genetic variants have been implicated in several fundamental classes of medications used in cardiovascular medicine.
CONTENT
In this review, we discuss genetic variants that affect drug response to 3 classes of cardiovascular drugs: statins, platelet P2Y12 inhibitors, and anticoagulants. These genetic variations have pharmacodynamic and pharmacokinetic effects and have been shown to explain differences in drug response such as lipid lowering, prevention of cardiovascular disease, and prevention of stroke, as well as incidence of adverse events such as musculoskeletal side effects and bleeding. Several groups have begun to implement pharmacogenetics testing as part of routine clinical care with the goal of improving health outcomes. Such strategies identify both patients at increased risk of adverse outcomes and alternative strategies to mitigate this risk as well as patients with “normal” genotypes, who, armed with this information, may have increased confidence and adherence to prescribed medications. While much is known about the genetic variants that underlie these effects, translation of this knowledge into clinical practice has been hampered by difficulty in implementing cost-effective, point-of-care tools to improve physician decision-making as well as a lack of data, as of yet, demonstrating the efficacy of using genetic information to improve health.
SUMMARY
Many genetic variants that affect individual responses to drugs used in cardiovascular disease prevention and treatment have been described. Further study of these variants is needed before successful implementation into clinical practice.
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Affiliation(s)
| | - Josephine Li
- Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC
| | - Deepak Voora
- Department of Medicine and and
- Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC
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SurvivalGWAS_Power: a user friendly tool for power calculations in pharmacogenetic studies with "time to event" outcomes. BMC Bioinformatics 2016; 17:523. [PMID: 27931206 PMCID: PMC5146816 DOI: 10.1186/s12859-016-1407-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/03/2016] [Indexed: 11/28/2022] Open
Abstract
Background Power calculators are currently available for the design of genetic association studies of binary phenotypes and quantitative traits, but not for “time to event” outcomes, which are of particular relevance in pharmacogenetics. With the rapid emergence of pharmacogenetic association studies of single nucleotide polymorphisms (SNPs), and the complexity of clinical outcomes they consider, there is a need for software to perform power calculations of time to event data over a range of design scenarios and analytical methodologies. Results We have developed the user friendly software tool SurvivalGWAS_Power to perform power calculations for time to event outcomes over a range of study designs and different analytical approaches. The software calculates the power to detect SNP association with a time to event outcome over a range of study design scenarios. The software enables analyses under a Cox proportional hazards model or Weibull regression model, and can account for treatment and SNP-treatment interaction effects. Simulated data sets can also be generated by SurvivalGWAS_Power to enable analyses with methods that are not currently supported by the power calculator, thereby increasing the flexibility of the software. Conclusions SurvivalGWAS_Power addresses the need for flexible and user-friendly software for power calculations for genetic association studies of time to event outcomes, with particular design features of relevance in pharmacogenetics. Electronic supplementary material The online version of this article (doi:10.1186/s12859-016-1407-9) contains supplementary material, which is available to authorized users.
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Haga SB, Mills R, Moaddeb J, Allen Lapointe N, Cho A, Ginsburg GS. Patient experiences with pharmacogenetic testing in a primary care setting. Pharmacogenomics 2016; 17:1629-1636. [PMID: 27648637 DOI: 10.2217/pgs-2016-0077] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIM To investigate patient experiences with pharmacogenetic (PGx) testing. METHODS Patients were offered PGx testing through a study on pharmacist-assisted delivery of PGx testing and invited to complete pre- and post-testing surveys about their experience. RESULTS Of 63 patients tested, 17 completed the baseline survey (27%). Interest in testing was mostly impacted by desire to inform selection of best treatment (n = 13). Seven of 12 patients that completed the follow-up survey indicated that their provider discussed the test result with them. Five patients understood their test result very or somewhat well. All would be likely to have PGx testing again. CONCLUSION Patients perceived PGx testing to be useful, though more effort may be needed to improve patient-provider communication of test results.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Durham, NC 27708, USA
| | - Rachel Mills
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Durham, NC 27708, USA
| | - Jivan Moaddeb
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Durham, NC 27708, USA
| | | | - Alex Cho
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Durham, NC 27708, USA
| | - Geoffrey S Ginsburg
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Durham, NC 27708, USA
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Chiang CE, Ferrières J, Gotcheva NN, Raal FJ, Shehab A, Sung J, Henriksson KM, Hermans MP. Suboptimal Control of Lipid Levels: Results from 29 Countries Participating in the Centralized Pan-Regional Surveys on the Undertreatment of Hypercholesterolaemia (CEPHEUS). J Atheroscler Thromb 2015; 23:567-87. [PMID: 26632163 DOI: 10.5551/jat.31179] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Five multicentre, cross-sectional Centralized Pan-Regional Surveys on the Undertreatment of Hypercholesterolaemia (CEPHEUS) were conducted in 29 countries across Asia, Western Europe, Eastern Europe, the Middle East, and Africa. The surveys assessed the current use and efficacy of lipid-lowering drugs (LLDs) worldwide and identified possible patient and physician characteristics associated with failure to attain low-density lipoprotein cholesterol (LDL-C) goals. The aim of this analysis was to consolidate the global results from these surveys. METHODS The surveys involved patients aged ≥18 years who had been prescribed LLDs for at least 3 months without dose changes for at least 6 weeks. A single visit was scheduled for data collection, including fasting plasma lipid and glucose levels. Cardiovascular risk profile and LDL-C goal attainment were assessed according to the 2004 updated US National Cholesterol Education Program Adult Treatment Panel III guidelines. RESULTS In total, 35 121 patients (mean age: 60.4 years) were included, and 90.3% had been prescribed statin monotherapy. Overall, only 49.4% of patients reached their recommended LDL-C level. LDL-C goals were attained in 54.8% (5084/9273) and 22.8% (3287/14 429) of patients were at high and very high cardiovascular risk, respectively. Factors associated with an increased likelihood of LDL-C goal attainment were lower baseline cardiovascular risk; presence of diabetes mellitus, hypertension, or history of cardiovascular disease; and treatment with simvastatin, atorvastatin, or rosuvastatin (vs. all other LLDs). CONCLUSION LDL-C goal attainment in patients taking LLDs is suboptimal worldwide, particularly in patients at high and very high cardiovascular risk.
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Affiliation(s)
- Chern-En Chiang
- General Clinical Research Center, Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University
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Shiffman D, Perez MV, Bare LA, Louie JZ, Arellano AR, Devlin JJ. Genetic risk for atrial fibrillation could motivate patient adherence to warfarin therapy: a cost effectiveness analysis. BMC Cardiovasc Disord 2015; 15:104. [PMID: 26419225 PMCID: PMC4587718 DOI: 10.1186/s12872-015-0100-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 09/18/2015] [Indexed: 12/12/2022] Open
Abstract
Background Atrial fibrillation (AF) increases risk of stroke, and although this stroke risk can be ameliorated by warfarin therapy, some patients decline to adhere to warfarin therapy. A prospective clinical study could be conducted to determine whether knowledge of genetic risk for AF could increase adherence to warfarin therapy for patients who initially declined therapy. As a prelude to a potential prospective clinical study, we investigated whether the use of genetic information to increase adherence could be cost effective. Methods Markov model assessed costs and utilities of two care strategies for AF patients who declined warfarin therapy. In the usual care strategy patients received aspirin. In the test strategy genetic risk for AF was assessed (genotype of the 4q25 locus) and some patients with a positive genetic test (≥1 risk allele) were assumed to adhere to warfarin therapy. The remaining patients received aspirin. The incremental cost-effectiveness ratio (ICER) was the ratio of the costs differential and the quality adjusted life-years (QALYs) differential for the two strategies. Results We found that the 4q25 genetic testing strategy, compared with the usual care strategy (aspirin therapy), would be cost-effective (ICER $ 47,148) if 2.1 % or more of the test positive patients were to adhere to warfarin therapy. The test strategy would become a cost saving strategy if 5.3 % or more of the test positive patients were to adhere to warfarin therapy. If 20 % of test positive patients were to adhere to warfarin therapy in a hypothetical cohort of 1000 patients, 7 stroke events would be prevented and 3 extra-cranial major bleeding events would be caused over 5 years, resulting in a cost savings of ~ $250,000 and a net gain of 9 QALYs. Discussion A clinical study to assess the impact of patient knowledge of genetic risk of AF on adherence to warfarin therapy would be merited because even a modest increase in patient adherence would make a genetic testing strategy cost-effective. Conclusion Providing patients who declined warfarin therapy with information about their genetic risk of AF would be cost effective if this genetic risk information resulted in modest increases in adherence.
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Affiliation(s)
- Dov Shiffman
- Quest Diagnostics, 1401 Harbor Bay Parkway, Alameda, CA, 94502, USA.
| | - Marco V Perez
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
| | - Lance A Bare
- Quest Diagnostics, 1401 Harbor Bay Parkway, Alameda, CA, 94502, USA.
| | - Judy Z Louie
- Quest Diagnostics, 1401 Harbor Bay Parkway, Alameda, CA, 94502, USA.
| | - Andre R Arellano
- Quest Diagnostics, 1401 Harbor Bay Parkway, Alameda, CA, 94502, USA.
| | - James J Devlin
- Quest Diagnostics, 1401 Harbor Bay Parkway, Alameda, CA, 94502, USA.
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Haga SB, LaPointe NMA, Cho A, Reed SD, Mills R, Moaddeb J, Ginsburg GS. Pilot study of pharmacist-assisted delivery of pharmacogenetic testing in a primary care setting. Pharmacogenomics 2015; 15:1677-86. [PMID: 25410893 DOI: 10.2217/pgs.14.109] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM To describe the rationale and design of a pilot program to implement and evaluate pharmacogenetic (PGx) testing in a primary care setting. STUDY RATIONALE Several factors have impeded the uptake of PGx testing, including lack of provider knowledge and challenges with operationalizing PGx testing in a clinical practice setting. STUDY DESIGN We plan to compare two strategies for the implementation of PGx testing: a pharmacist-initiated testing arm compared with a physician-initiated PGx testing arm. Providers in both groups will be required to attend an introduction to PGx seminar. Anticipated results: We anticipate that providers in the pharmacist-initiated group will be more likely to order PGx testing than providers in the physician-initiated group. CONCLUSION Overall, we aim to generate data that will inform an effective delivery model for PGx testing and to facilitate a seamless integration of PGx testing in primary care practices.
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Affiliation(s)
- Susanne B Haga
- Duke University Center for Applied Genomics & Precision Medicine, 304 Research Drive, Box 90141 Durham, NC 27708, USA
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Vishnuprabu D, Geetha S, Bhaskar LVKS, Mahapatra NR, Munirajan AK. Genotyping and meta-analysis of KIF6 Trp719Arg polymorphism in South Indian Coronary Artery Disease patients: A case-control study. Meta Gene 2015; 5:129-34. [PMID: 26236646 PMCID: PMC4513186 DOI: 10.1016/j.mgene.2015.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 06/08/2015] [Accepted: 07/03/2015] [Indexed: 11/30/2022] Open
Abstract
The KIF6 719Arg allele is an interesting genomic variant widely screened in various populations and is reported to be associated with the risk of Coronary Artery Disease (CAD) and statin treatment outcome. Recent population based clinical studies and large-scale meta-analyses pondered over the role of 719Arg variant in CAD risk and treatment response. We screened the KIF6 Trp719Arg polymorphism (rs20455) in south Indian CAD patients in a case–control approach. A total of 1042 samples (510 CAD patients and 532 controls) were screened for the KIF6 Trp719Arg SNP by TaqMan SNP genotyping assay, followed by meta-analysis of the genotype data of non-Europeans reports. The 719Arg risk genotype (GG) was observed in 29.6% of CAD cases and in 30.1% of controls with an odds ratio (OR) of 1.07 (95% CI: 0.76–1.50), p value = 0.709. No significant difference in the genotype frequency was observed between CAD and controls in both dominant model (AG + GG vs AA) and allelic model (719Arg vs 719Trp) with an OR of 1.11 (p = 0.491) and 1.03 (p = 0.767), respectively. The covariate analysis indicated that smoking & alcohol consumption increased the risk for MI among CAD patients. Meta-analysis showed that the KIF6 719Arg allele is not associated with CAD risk in both fixed effect (p = 0.515, OR = 1.023, 95% CI = 0.956–1.094) and random effect (p = 0.547, OR = 1.022, 95% CI = 0.953–1.096). The symmetrical shape of the Egger's funnel plots revealed that there is no publication bias. These results suggest that there is no association of KIF6 719Arg allele with CAD risk in South Indian population and the meta-analysis confirms the same among non-European population. First study to screen for KIF6Trp719Arg SNP in south Indian population KIF6Arg variant is not a risk factor for south Indian CAD patients. Meta-analysis showed no association of KIF6Arg allele in non-European CAD populations. Smoking and alcoholic status were strong risk factors for MI; whereas KIF6 status is not.
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Affiliation(s)
- Durairajpandian Vishnuprabu
- Department of Genetics, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai 600 113, India
| | - Subramanian Geetha
- Department of Cardiology, Madras Medical College and Government General Hospital, Chennai 600 003, India
| | | | - Nitish R Mahapatra
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology Madras, 600 036, India
| | - Arasambattu K Munirajan
- Department of Genetics, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani, Chennai 600 113, India
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The MYLIP p.N342S polymorphism is associated with response to lipid-lowering therapy in Brazilian patients with familial hypercholesterolemia. Pharmacogenet Genomics 2015; 24:548-55. [PMID: 25171759 PMCID: PMC4206345 DOI: 10.1097/fpc.0000000000000089] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Supplemental Digital Content is available in the text. Background A previous study reported that the myosin regulatory light chain interacting protein (MYLIP) might serve as a novel therapeutic class for treating dyslipidemia. It contributes to variations in the levels of circulating low-density lipoprotein cholesterol (LDL-C), promoting the degradation of LDL–LDLR, thus limiting absorption. The effect of genetic variation in the MYLIP gene in a disease scenario characterized by mutations in the LDLR gene has not been previously evaluated. Objective The aim of this study was to assess the effect of the p.N342S variant on the response to lipid-lowering therapy in Brazilian patients with heterozygous familial hypercholesterolemia (FH). Patients and methods A total of 156 patients with heterozygous FH were followed up for 12 months and received lipid-lowering therapy (different doses of atorvastatin with the addition of ezetimibe in over half the patients of each genotype group). Cholesterol data were assessed, and analysis of the MYLIP rs9370867 (p.N342S) genotypes was carried out by melting curve analysis. Results Baseline total cholesterol and baseline LDL-C levels were not different between genotypes. After 1 year of treatment, LDL-C responses (expressed as mg/dl and as %) were significantly different among genotypes (AA: −79±68 and −39±27, GA: −60±79 and −27±32, and GG: −30±83 and −15±38; P=0.02 and 0.005, respectively). In addition, FH patients carrying the AA genotype were more likely to achieve LDL-C levels of less than 130 mg/dl after 1 year of treatment (75.0%) compared with patients with the GG and GA genotypes (34.5 and 34.8%, respectively; P=0.001). Conclusion Our study indicates that MYLIP p.N342S might be a pharmacogenetic marker for lipid-lowering therapy in patients with FH.
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Pellegrino P, Falvella FS, Perrone V, Carnovale C, Brusadelli T, Pozzi M, Antoniazzi S, Cheli S, Perrotta C, Clementi E, Radice S. The first steps towards the era of personalised vaccinology: predicting adverse reactions. THE PHARMACOGENOMICS JOURNAL 2014; 15:284-7. [PMID: 25287071 DOI: 10.1038/tpj.2014.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/01/2014] [Accepted: 08/21/2014] [Indexed: 01/11/2023]
Abstract
Until now, the occurrence of adverse reactions among individuals inoculated with identical vaccines has been ascribed to unpredictable stochastic processes. Recent advances in pharmacogenomics indicate that some features of host response to immunisation are influenced by genetic traits, henceforth predictable. The ability to predict the adverse reaction to vaccination would represent an important step towards the development of personalised vaccinology and could enhance public confidence in the safety of vaccines. Herein, we have reviewed all the available information on the association between genetic variants and the risk for healthy subjects to develop adverse reactions.
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Affiliation(s)
- P Pellegrino
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - F S Falvella
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - V Perrone
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - C Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - T Brusadelli
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - M Pozzi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - S Antoniazzi
- IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Cheli
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - C Perrotta
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - E Clementi
- 1] Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy [2] Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
| | - S Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital 'Luigi Sacco', Universitá di Milano, Milan, Italy
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Abstract
Advances in pharmacogenetic research have improved our understanding of adverse drug responses and have led to the development of pharmacogenetic tests and targeted drugs. However, the extent of the communication process and provision of information to patients about pharmacogenetics is unclear. Pharmacogenetic information may be included in sections of a drug's package insert intended for patients, which is provided directly to patients or communicated via the health provider. To determine what pharmacogenetic information, if any, is included in patient-targeted sections of the drug label, we reviewed the labels listed in the US Food and Drug Administration's Table of Pharmacogenomic Biomarkers in Drug Labels. To date, 140 drugs include pharmacogenetic-related information in the approved label. Our analysis revealed that pharmacogenetic information is included in patient-targeted sections for a minority (n=29; 21%) of drug labels, with no obvious pattern associated with the inclusion of pharmacogenetic information. Therefore, patients are unlikely to learn about pharmacogenetics through written materials dispensed with the drug. Given that there are also inconsistencies with regard to inclusion of pharmacogenetic information in the patient counseling information section, it is also unlikely that patients are receiving adequate pharmacogenetic information from their provider. The inconsistent presence of pharmacogenetic information in patient-targeted sections of drug labels suggests a need to review the criteria for inclusion of information in patient-targeted sections in order to increase consistency and patient knowledge of pharmacogenetic information.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Rachel Mills
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Jivan Moaddeb
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC, USA
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Abstract
The incidence of type 2 diabetes (T2D) and its costs to the health care system continue to rise. Despite the availability of at least 10 drug classes for the treatment of T2D, metformin remains the most widely used first-line pharmacotherapy for its treatment; however, marked interindividual variability in response and few clinical or biomarker predictors of response reduce its optimal use. As clinical care moves toward precision medicine, a variety of broad discovery-based "omics" approaches will be required. Technical innovation, decreasing sequencing cost, and routine sample storage and processing has made pharmacogenomics the most widely applied discovery-based approach to date. This opens up the opportunity to understand the genetics underlying the interindividual variation in metformin responses in order for clinicians to prescribe specific treatments to given individuals for better efficacy and safety: metformin for those predicted to respond and alternative therapies for those predicted to be nonresponders or who are at increased risk for adverse side effects. Furthermore, understanding of the genetic determinants of metformin response may lead to the identification of novel targets and development of more effective agents for diabetes treatment. The goals of this workshop sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases were to review the state of research on metformin pharmacogenomics, discuss the scientific and clinical hurdles to furthering our knowledge of the variability in patient responses to metformin, and consider how to effectively use this increased understanding to improve patient outcomes.
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Affiliation(s)
- Aaron C Pawlyk
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Kathleen M Giacomini
- Department of Bioengineering and Therapeutic Sciences and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA
| | - Catherine McKeon
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Alan R Shuldiner
- Division of Endocrinology, Diabetes and Nutrition and Program for Personalized and Genomic Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jose C Florez
- Center for Human Genetic Research and Diabetes Research Center (Diabetes Unit), Massachusetts General Hospital, Boston, MA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA; and Department of Medicine, Massachusetts General Hospital, Boston, MA
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Li JH, Joy SV, Haga SB, Orlando LA, Kraus WE, Ginsburg GS, Voora D. Genetically guided statin therapy on statin perceptions, adherence, and cholesterol lowering: a pilot implementation study in primary care patients. J Pers Med 2014; 4:147-62. [PMID: 25563221 PMCID: PMC4263970 DOI: 10.3390/jpm4020147] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/04/2014] [Accepted: 03/17/2014] [Indexed: 11/16/2022] Open
Abstract
Statin adherence is often limited by side effects. The SLCO1B1*5 variant is a risk factor for statin side effects and exhibits statin-specific effects: highest with simvastatin/atorvastatin and lowest with pravastatin/rosuvastatin. The effects of SLCO1B1*5 genotype guided statin therapy (GGST) are unknown. Primary care patients (n = 58) who were nonadherent to statins and their providers received SLCO1B1*5 genotyping and guided recommendations via the electronic medical record (EMR). The primary outcome was the change in Beliefs about Medications Questionnaire, which measured patients' perceived needs for statins and concerns about adverse effects, measured before and after SLCO1B1*5 results. Concurrent controls (n = 59) were identified through the EMR to compare secondary outcomes: new statin prescriptions, statin utilization, and change in LDL-cholesterol (LDL-c). GGST patients had trends (p = 0.2) towards improved statin necessity and concerns. The largest changes were the "need for statin to prevent sickness" (p < 0.001) and "concern for statin to disrupt life" (p = 0.006). GGST patients had more statin prescriptions (p < 0.001), higher statin use (p < 0.001), and greater decrease in LDL-c (p = 0.059) during follow-up. EMR delivery of SLCO1B1*5 results and recommendations is feasible in the primary care setting. This novel intervention may improve patients' perceptions of statins and physician behaviors that promote higher statin adherence and lower LDL-c.
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Affiliation(s)
- Josephine H Li
- Center for Personalized and Precision Medicine, Duke University Medical Center, Durham, NC 27708, USA.
| | - Scott V Joy
- Division of General Internal Medicine, Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO 80045, USA.
| | - Susanne B Haga
- Center for Personalized and Precision Medicine, Duke University Medical Center, Durham, NC 27708, USA.
| | - Lori A Orlando
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
| | - William E Kraus
- Division of Cardiovascular Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
| | - Geoffrey S Ginsburg
- Center for Personalized and Precision Medicine, Duke University Medical Center, Durham, NC 27708, USA.
| | - Deepak Voora
- Center for Personalized and Precision Medicine, Duke University Medical Center, Durham, NC 27708, USA.
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Haga SB, LaPointe NMA. The potential impact of pharmacogenetic testing on medication adherence. THE PHARMACOGENOMICS JOURNAL 2013; 13:481-3. [PMID: 23999596 PMCID: PMC3969027 DOI: 10.1038/tpj.2013.33] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/06/2013] [Accepted: 07/22/2013] [Indexed: 01/22/2023]
Abstract
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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Affiliation(s)
- Susanne B. Haga
- Institute for Genome Sciences & Policy, Duke University, 304 Research Drive, Box 90141, Durham, NC 27708, Tel: 919.684.0325, Fax: 919.613.6448,
| | - Nancy M. Allen LaPointe
- Associate Professor of Medicine, Duke University, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27710, Phone: 919-668-8529,
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Maningat P, Gordon BR, Breslow JL. How do we improve patient compliance and adherence to long-term statin therapy? Curr Atheroscler Rep 2013; 15:291. [PMID: 23225173 DOI: 10.1007/s11883-012-0291-7] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Statins are highly effective drugs prescribed to millions of people to lower LDL-cholesterol and decrease cardiovascular risk. The benefits of statin therapy seen in randomized clinical trials will only be replicated in real-life if patients adhere to the prescribed treatment regimen. But, about half of patients discontinue statin therapy within the first year, and adherence decreases with time. Patient, physician and healthcare system-related factors play a role in this problem. Recent studies have focused more on the patients' perspectives on non-adherence. Adverse events are cited as the most common cause of statin discontinuation; thus, the healthcare provider must be willing to ally and dialogue with patients to address concerns and assess the risks and benefits of continued statin therapy.
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Statin pharmacogenomics: opportunities to improve patient outcomes and healthcare costs with genetic testing. J Pers Med 2012; 2:158-74. [PMID: 25562358 PMCID: PMC4251374 DOI: 10.3390/jpm2040158] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 10/01/2012] [Accepted: 10/10/2012] [Indexed: 01/07/2023] Open
Abstract
HMG-CoA reductase inhibitors, commonly known as statins, are some of the most widely prescribed medications worldwide and have been shown to be effective at lowering cholesterol in numerous long-term prospective trials, yet there are significant limitations to their use. First, patients receiving statin therapy have relatively low levels of medication adherence compared with other drug classes. Next, numerous statin formulations are available, each with its own unique safety and efficacy profile, and it may be unclear to prescribers which treatment is optimal for their patients. Finally, statins have class-wide side effects of myopathy and rhabdomyolysis that have resulted in a product recall and dosage limitations. Recent evidence suggests that two genomic markers, KIF6 and SLCO1B1, may inform the therapy choice of patients initiating statins. Given the prevalence of statin usage, their potential health advantages and their overall cost to the healthcare system, there could be significant clinical benefit from creating personalized treatment regimens. Ultimately, if this approach is effective it may encourage higher adoption of generic statins when appropriate, promote adherence, lower rates of myopathy, and overall achieve higher value cardiovascular care. This paper will review the evidence for personalized prescribing of statins via KIF6 and SLCO1B1 and consider some of the implications for testing these markers as part of routine clinical care.
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Affiliation(s)
- Robert S. Epstein
- Department of Advanced Clinical Science and Research, Medco Health SolutionsFranklin Lakes, NJ
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