1
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Hahn M, Frantz AM, Eckert A, Reif A. [Barriers for Implementation of PGx Testing in Psychiatric Hospitals in Germany: Results of the FACT-PGx Study]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024; 92:221-229. [PMID: 37130546 DOI: 10.1055/a-2060-0694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The FACT-PGx study was conducted to analyze barriers to implementation of pharmacogenetic testing in psychiatric hospitals in Germany and to propose solutions for its faster and easier implementation in all hospitals. METHODS 104 patients (50% female) were genotyped and participated in the study. 67 completed a survey. To analyze the correlation between continuous data (age) of the survey, the wilcoxon rank test and for categorial data (education level, history of treatment and episodes), t-test was used. RESULTS No patient declined to be genotyped. 99% believed that genotyping could help to shorten their hospital stay. Patients >40 years of age and with higher educational levels were willing to pay for the PGx (p=0.009). On average, patients were willing to pay 117.42€ +/-140.49€ and to wait 15.83+/- 8.92 days for the results. Processes differed significantly between routine laboratory screening and PGx testing which could be a barrier for implementation. CONCLUSION Patients are not barriers to but enablers of an implementation of PGx. New process flows can be barriers, but can be overcome by optimization.
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Affiliation(s)
- Martina Hahn
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
- Klinik für psychische Gesundheit, varisano Klinikum Frankfurt Hoechst, Frankfurt, Germany
| | - Amelie Merle Frantz
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Andreas Eckert
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Andreas Reif
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
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2
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Cernat A, Samaan Z, Abelson J, Ramdyal A, Shaikh H, Vanstone M. Patient perspectives on pharmacogenomic (PGx) testing for antidepressant prescribing in primary care: a qualitative description study. J Community Genet 2024; 15:293-309. [PMID: 38587601 PMCID: PMC11217204 DOI: 10.1007/s12687-024-00705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024] Open
Abstract
Many patients with major depressive disorder (MDD) try multiple antidepressants before finding one that works well and is tolerable. Pharmacogenomic (PGx) testing was developed to facilitate more efficacious prescribing. This technology has not been robustly implemented clinically. Patient perspectives are critical to policy decisions, but the views of patients with MDD about the use of PGx testing to guide antidepressant prescribing have not been extensively examined, particularly in publicly funded healthcare systems. The purpose of this qualitative description study was to produce actionable patient perspectives evidence to inform future technology assessment of PGx testing. We conducted semi-structured interviews with 21 adults with MDD for which antidepressants were indicated in Ontario, Canada, and used the Ontario Decision Determinants Framework to conduct an unconstrained deductive content analysis. Patients expressed views about the overall clinical benefit of PGx testing in depression care, preferences for deployment of testing, perspectives on ethical considerations, opinions about equity and patient care, and beliefs regarding the feasibility of adopting PGx testing into the healthcare system. They also worried about the possibility of conflicts of interest between PGx test manufacturers and pharmaceutical companies. This study provides policymakers with patient priorities to facilitate the development of patient-centred policies. It highlights that formal adoption of PGx testing into the healthcare system requires a focus on equity of access and health outcomes.
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Affiliation(s)
- Alexandra Cernat
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada
- Health Policy PhD Program, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, L8S 4L8, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, L8S 4L8, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, L8S 4L8, Canada
| | - Amanada Ramdyal
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada
| | - Hadia Shaikh
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada
- Biomedical Discovery and Commercialization Program, Faculty of Health Sciences, McMaster University, Hamilton, L8S 4L8, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, ON, L8P 1H6, Canada.
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3
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Roberts B, Cooper Z, Lu S, Stanley S, Majda BT, Collins KRL, Gilkes L, Rodger J, Akkari PA, Hood SD. Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review. Front Pharmacol 2023; 14:1267294. [PMID: 37795032 PMCID: PMC10545970 DOI: 10.3389/fphar.2023.1267294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Pharmacogenetics (PGx) is the study and application of how interindividual differences in our genomes can influence drug responses. By evaluating individuals' genetic variability in genes related to drug metabolism, PGx testing has the capabilities to individualise primary care and build a safer drug prescription model than the current "one-size-fits-all" approach. In particular, the use of PGx testing in psychiatry has shown promising evidence in improving drug efficacy as well as reducing toxicity and adverse drug reactions. Despite randomised controlled trials demonstrating an evidence base for its use, there are still numerous barriers impeding its implementation. This review paper will discuss the management of mental health conditions with PGx-guided treatment with a strong focus on youth mental illness. PGx testing in clinical practice, the concerns for its implementation in youth psychiatry, and some of the barriers inhibiting its integration in clinical healthcare will also be discussed. Overall, this paper provides a comprehensive review of the current state of knowledge and application for PGx in psychiatry and summarises the capabilities of genetic information to personalising medicine for the treatment of mental ill-health in youth.
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Affiliation(s)
- Bradley Roberts
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - Zahra Cooper
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Stephanie Lu
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Susanne Stanley
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | | | - Khan R. L. Collins
- Western Australian Department of Health, North Metropolitan Health Service, Perth, WA, Australia
| | - Lucy Gilkes
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
- Divison of General Practice, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Jennifer Rodger
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - P. Anthony Akkari
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia
- Division of Neurology, Duke University Medical Centre, Duke University, Durham, United States
| | - Sean D. Hood
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
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4
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Lemke LK, Alam B, Williams R, Starostik P, Cavallari LH, Cicali EJ, Wiisanen K. Reimbursement of pharmacogenetic tests at a tertiary academic medical center in the United States. Front Pharmacol 2023; 14:1179364. [PMID: 37645439 PMCID: PMC10461057 DOI: 10.3389/fphar.2023.1179364] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/17/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction: Pharmacogenetics (PGx) has the potential to improve health outcomes but cost of testing is a barrier for equitable access. Reimbursement by insurance providers may lessen the financial burden for patients, but the extent to which PGx claims are covered in clinical practice has not been well-characterized in the literature. Methods: A retrospective analysis of outpatient claims submitted to payers for PGx tests from 1/1/2019 through 12/31/2021 was performed. A reimbursement rate was calculated and compared across specific test types (e.g., single genes, panel), payers, indication, and the year the claim was submitted. Results: A total of 1,039 outpatient claims for PGx testing were analyzed. The overall reimbursement rate was 46% and ranged from 36%-48% across payers. PGx panels were reimbursed at a significantly higher rate than single gene tests (74% vs. 43%, p < 0.001). Discussion: Reimbursement of claims for PGx testing is variable based on the test type, indication, year the claim was submitted, number of diagnosis codes submitted, and number of unique diagnosis codes submitted. Due to the highly variable nature of reimbursement, cost and affordability should be discussed with each patient.
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Affiliation(s)
- Lauren K. Lemke
- Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, United States
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, United States
| | - Benish Alam
- Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, United States
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, United States
| | - Roy Williams
- Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, United States
| | - Petr Starostik
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, United States
- UF Health Pathology Laboratories, UF Health, Gainesville, FL, United States
| | - Larisa H. Cavallari
- Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, United States
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, United States
| | - Emily J. Cicali
- Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, United States
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, United States
| | - Kristin Wiisanen
- Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL, United States
- Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, United States
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5
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Miller EG, Young JL, Rao A, Ward-Lev E, Halley MC. Demographic Characteristics Associated With Perceptions of Personal Utility in Genetic and Genomic Testing: A Systematic Review. JAMA Netw Open 2023; 6:e2310367. [PMID: 37145601 PMCID: PMC10163389 DOI: 10.1001/jamanetworkopen.2023.10367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/14/2023] [Indexed: 05/06/2023] Open
Abstract
Importance The expansion of genetic and genomic testing in health care has led to recognition that these tests provide personal as well as clinical utility to patients and families. However, available systematic reviews on this topic have not reported the demographic backgrounds of participants in studies of personal utility, leaving generalizability unclear. Objective To determine the demographic characteristics of participants in studies examining the personal utility of genetic and genomic testing in health care. Evidence Review For this systematic review, we utilized and updated the results of a highly cited 2017 systematic review on the personal utility of genetics and genomics, which identified relevant articles published between January 1, 2003, and August 4, 2016. We also used the original methods to update this bibliography with literature published subsequently up to January 1, 2022. Studies were screened for eligibility by 2 independent reviewers. Eligible studies reported empirical data on the perspectives of patients, family members, and/or the general public in the US on the personal utility of any type of health-related genetic or genomic test. We utilized a standardized codebook to extract study and participant characteristics. We summarized demographic characteristics descriptively across all studies and by subgroup based on study and participant characteristics. Findings We included 52 studies with 13 251 eligible participants. Sex or gender was the most frequently reported demographic characteristic (48 studies [92.3%]), followed by race and ethnicity (40 studies [76.9%]), education (38 studies [73.1%]), and income (26 studies [50.0%]). Across studies, participants disproportionately were women or female (mean [SD], 70.8% [20.5%]), were White (mean [SD], 76.1% [22.0%]), had a college degree or higher (mean [SD], 64.5% [19.9%]), and reported income above the US median (mean [SD], 67.4% [19.2%]). Examination of subgroups of results by study and participant characteristics evidenced only small shifts in demographic characteristics. Conclusions and Relevance This systematic review examined the demographic characteristics of individual participants in studies of the personal utility of health-related genetic and genomic testing in the US. The results suggest that participants in these studies were disproportionately White, college-educated women with above-average income. Understanding the perspectives of more diverse individuals regarding the personal utility of genetic and genomic testing may inform barriers to research recruitment and uptake of clinical testing in currently underrepresented populations.
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Affiliation(s)
- Emily G. Miller
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
| | - Jennifer L. Young
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anoushka Rao
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
| | - Eliana Ward-Lev
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
| | - Meghan C. Halley
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
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6
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Slomp C, Morris E, Edwards L, Hoens AM, Landry G, Riches L, Ridgway L, Bryan S, Austin J. Pharmacogenomic Testing for Major Depression: A Qualitative Study of the Perceptions of People with Lived Experience and Professional Stakeholders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022:7067437221140383. [PMID: 36437757 DOI: 10.1177/07067437221140383] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES With increasing evidence for the clinical utility of pharmacogenomic (PGx) testing for depression, there is a growing need to consider issues related to the clinical implementation of this testing. The perspectives of key stakeholders (both people with lived experience [PWLE] and providers) are critical, but not frequently explored. The purpose of this study was to understand how PWLE and healthcare providers/policy experts (P/HCPs) perceive PGx testing for depression, to inform the consideration of clinical implementation within the healthcare system in British Columbia (BC), Canada. METHODS We recruited two cohorts of participants to complete individual 1-h, semi-structured interviews: (a) PWLE, recruited from patient and research engagement networks and organizations and (b) P/HCPs, recruited via targeted invitation. Interviews were audiotaped, transcribed verbatim, de-identified, and analysed using interpretive description. RESULTS Seventeen interviews were completed with PWLE (7 with experience of PGx testing for depression; 10 without); 15 interviews were completed with P/HCPs (family physicians, psychiatrists, nurses, pharmacists, genetic counsellors, medical geneticists, lab technologists, program directors, and insurers). Visual models of PWLE's and P/HCP's perceptions of and attitudes towards PGx testing were developed separately, but both were heavily influenced by participants' prior professional and/or personal experiences with depression and/or PGx testing. Both groups expressed a need for evidence and numerous considerations for the implementation of PGx testing in BC, including the requirement for conclusive economic analyses, patient and provider education, technological and clinical support, local testing facilities, and measures to ensure equitable access to testing. CONCLUSIONS While hopeful about the potential for therapeutic benefit from PGx testing, PWLE and P/HCPs see the need for robust evidence of utility, and BC-wide infrastructure and policies to ensure equitable and effective access to PGx testing. Further research into the accessibility, effectiveness, and cost-effectiveness of various implementation strategies is needed to inform PGx testing use in BC.
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Affiliation(s)
- Caitlin Slomp
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - Emily Morris
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - Louisa Edwards
- School of Population & Public Health, 8166University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Alison M Hoens
- Department of Physical Therapy, 8166University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada
| | | | | | | | - Stirling Bryan
- School of Population & Public Health, 8166University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Jehannine Austin
- Department of Psychiatry, 8166University of British Columbia, Vancouver, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada
- Department of Medical Genetics, 8166University of British Columbia, Vancouver, Canada
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7
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Cytochromes P450 and P-Glycoprotein Phenotypic Assessment to Optimize Psychotropic Pharmacotherapy: A Retrospective Analysis of Four Years of Practice in Psychiatry. J Pers Med 2022; 12:jpm12111869. [PMID: 36579580 PMCID: PMC9693601 DOI: 10.3390/jpm12111869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Altered cytochromes P450 enzymes (CYP) and P-glycoprotein transporter (P-gp) activity may explain variabilities in drug response. In this study, we analyzed four years of phenotypic assessments of CYP/P-gp activities to optimize pharmacotherapy in psychiatry. A low-dose probe cocktail was administered to evaluate CYP1A2, 2B6, 2D6, 2C9, 2C19, 3A4, and P-gp activities using the probe/metabolite concentration ratio in blood or the AUC. A therapeutic adjustment was suggested depending on the phenotyping results. From January 2017 to June 2021, we performed 32 phenotypings, 10 for adverse drug reaction, 6 for non-response, and 16 for both reasons. Depending on the CYP/P-gp evaluated, only 23% to 56% of patients had normal activity. Activity was decreased in up to 57% and increased in up to 60% of cases, depending on the CYP/P-gp evaluated. In 11/32 cases (34%), the therapeutic problem was attributable to the patient's metabolic profile. In 10/32 cases (31%), phenotyping excluded the metabolic profile as the cause of the therapeutic problem. For all ten individuals for which we had follow-up information, phenotyping allowed us to clearly state or clearly exclude the metabolic profile as a possible cause of therapeutic failure. Among them, seven showed a clinical improvement after dosage adaptation, or drug or pharmacological class switching. Our study confirmed the interest of CYP and P-gp phenotyping for therapeutic optimization in psychiatry.
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8
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Scherf-Clavel M, Weber H, Wurst C, Stonawski S, Hommers L, Unterecker S, Wolf C, Domschke K, Rost N, Brückl T, Lucae S, Uhr M, Binder EB, Menke A, Deckert J. Effects of Pharmacokinetic Gene Variation on Therapeutic Drug Levels and Antidepressant Treatment Response. PHARMACOPSYCHIATRY 2022; 55:246-254. [PMID: 35839823 PMCID: PMC9458342 DOI: 10.1055/a-1872-0613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction
Pharmacogenetic testing is proposed to minimize adverse
effects when considered in combination with pharmacological knowledge of the
drug. As yet, limited studies in clinical settings have investigated the
predictive value of pharmacokinetic (pk) gene variation on therapeutic drug
levels as a probable mechanism of adverse effects, nor considered the combined
effect of pk gene variation and drug level on antidepressant treatment
response.
Methods
Two depression cohorts were investigated for the relationship
between pk gene variation and antidepressant serum concentrations of
amitriptyline, venlafaxine, mirtazapine and quetiapine, as well as treatment
response. For the analysis, 519 patients (49% females; 46.6±14.1
years) were included.
Results
Serum concentration of amitriptyline was associated with
CYP2D6
(higher concentrations in poor metabolizers compared to normal
metabolizers), of venlafaxine with
CYP2C19
(higher concentrations in
intermediate metabolizers compared to rapid/ultrarapid metabolizers) and
CYP2D6
(lower metabolite-to-parent ratio in poor compared to
intermediate and normal metabolizers, and intermediate compared to normal and
ultrarapid metabolizers). Pk gene variation did not affect treatment
response.
Discussion
The present data support previous recommendations to reduce
starting doses of amitriptyline and to guide dose-adjustments via therapeutic
drug monitoring in CYP2D6 poor metabolizers. In addition, we propose including
CYP2C19
in routine testing in venlafaxine-treated patients to improve
therapy by raising awareness of the risk of low serum concentrations in CYP2C19
rapid/ultrarapid metabolizers. In summary, pk gene variation can predict
serum concentrations, and thus the combination of pharmacogenetic testing and
therapeutic drug monitoring is a useful tool in a personalized therapy approach
for depression.
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Affiliation(s)
- Maike Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Heike Weber
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Catherina Wurst
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Interdisciplinary Center for Clinical Research, University Hospital of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Würzburg, Germany
| | - Saskia Stonawski
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Interdisciplinary Center for Clinical Research, University Hospital of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Würzburg, Germany
| | - Leif Hommers
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Interdisciplinary Center for Clinical Research, University Hospital of Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Würzburg, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Christiane Wolf
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicolas Rost
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany.,International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Tanja Brückl
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | | | - Manfred Uhr
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Elisabeth B Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Andreas Menke
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Park Chiemseeblick, Bernau, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
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9
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Martin JL, Lee YM, Corbin LW, Colson R, Aquilante CL. Patients' perspectives of a pharmacist-provided clinical pharmacogenomics service. Pharmacogenomics 2022; 23:463-474. [PMID: 35469451 DOI: 10.2217/pgs-2022-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: To assess the perspectives and experiences of patients who participated in a pharmacist-provided clinical pharmacogenomics (PGx) service. Methods: We conducted individual semistructured interviews with 16 patients who received a pharmacist-provided PGx service. Qualitative data were analyzed to identify pertinent themes. Results: The major themes identified were: heterogeneity of patient PGx experiences and preferences, pharmacists as appropriate providers of PGx services, considerations regarding the use of PGx results in routine healthcare, and perceived applications of PGx testing. Theme-derived considerations included the need to establish appropriate pre-genotyping expectations, individualize patient education, facilitate collaboration with patients' providers and sustainably update patients' PGx information over time. Conclusion: Patient-specific perspectives such as these are important to consider when providing clinical PGx services, with intention of optimizing patient experiences.
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Affiliation(s)
- James L Martin
- Department of Pharmaceutical Sciences, University of Colorado, Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80045, USA
| | - Yee Ming Lee
- Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80045, USA
| | - Lisa W Corbin
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Ronald Colson
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado, Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80045, USA
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10
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Anderson HD, Thant TM, Kao DP, Crooks KR, Mendola N, Aquilante CL. Pharmacogenetic testing among patients with depression in a US managed care population. Clin Transl Sci 2022; 15:1644-1653. [PMID: 35385214 PMCID: PMC9283740 DOI: 10.1111/cts.13279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/14/2022] [Accepted: 03/10/2022] [Indexed: 12/01/2022] Open
Abstract
Actionable drug–gene pairs relevant to depression treatment include CYP2D6 and CYP2C19 with specific antidepressants. While clinical use of pharmacogenetic testing is growing, little is known about pharmacogenetic testing for depression treatment in managed care. We determined the incidence of single‐gene CYP2D6 and CYP2C19 testing following a new depression episode among US managed care patients, and described characteristics and antidepressant use of patients receiving tests. We used paid medical and pharmacy claims for patients from commercial health plans in the US. For adult patients with a new depression episode from January 1, 2013 to June 30, 2018, we identified covered claims for single‐gene CYP2D6 and CYP2C19 pharmacogenetic tests and antidepressant fills. Fewer than 1% (n = 1795) of the depressed cohort (n = 438,534) received a single‐gene CYP2D6 or CYP2C19 test through their insurance within 365 days of their earliest depression episode. The percentage of patients who received a test nearly tripled from 0.2% in 2013 to 0.5% in 2014 before plateauing at 0.4% from 2014 to 2017. Among the patients who received a single‐gene CYP2D6 or CYP2C19 test and filled an antidepressant within 365 days of their depression diagnosis, up to 30% may have had their initial antidepressant informed by the test result. Our findings describe the use of antidepressants before and after pharmacogenetic testing, which is clinically relevant as pharmacogenomic testing becomes more common in clinical practice. Our study also emphasizes the need for procedure and billing codes that capture multiple‐gene panel tests to be more widely implemented in administrative databases.
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Affiliation(s)
- Heather D Anderson
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Thida M Thant
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David P Kao
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kristy R Crooks
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicholas Mendola
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
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11
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Allen JD, Pittenger AL, Bishop JR. A Scoping Review of Attitudes and Experiences with Pharmacogenomic Testing among Patients and the General Public: Implications for Patient Counseling. J Pers Med 2022; 12:jpm12030425. [PMID: 35330430 PMCID: PMC8953117 DOI: 10.3390/jpm12030425] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/16/2022] Open
Abstract
The use of pharmacogenomic (PGx) tests is increasing, but there are not standard approaches to counseling patients on their implications or results. To inform approaches for patient counseling, we conducted a scoping review of published literature on patient experiences with PGx testing and performed a thematic analysis of qualitative and quantitative reports. A structured scoping review was conducted using Joanna Briggs Institute guidance. The search identified 37 articles (involving n = 6252 participants) published between 2010 and 2021 from a diverse range of populations and using a variety of study methodologies. Thematic analysis identified five themes (reasons for testing/perceived benefit, understanding of results, psychological response, impact of testing on patient/provider relationship, concerns about testing/perceived harm) and 22 subthemes. These results provide valuable context and potential areas of focus during patient counseling on PGx. Many of the knowledge gaps, misunderstandings, and concerns that participants identified could be mitigated by pre- and post-test counseling. More research is needed on patients’ PGx literacy needs, along with the development of a standardized, open-source patient education curriculum and the development of validated PGx literacy assessment tools.
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Affiliation(s)
- Josiah D. Allen
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA;
- Medigenics Consulting, LLC, Minneapolis, MN 55407, USA
| | - Amy L. Pittenger
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Jeffrey R. Bishop
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA;
- Department of Psychiatry and Behavioral Sciences, Medical School, University of Minnesota, Minneapolis, MN 55455, USA
- Correspondence:
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12
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Jameson A, Fylan B, Bristow GC, Sagoo GS, Dalton C, Cardno A, Sohal J, McLean SL. What Are the Barriers and Enablers to the Implementation of Pharmacogenetic Testing in Mental Health Care Settings? Front Genet 2021; 12:740216. [PMID: 34630531 PMCID: PMC8493030 DOI: 10.3389/fgene.2021.740216] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/30/2021] [Indexed: 01/29/2023] Open
Abstract
In psychiatry, the selection of antipsychotics and antidepressants is generally led by a trial-and-error approach. The prescribing of these medications is complicated by sub-optimal efficacy and high rates of adverse drug reactions (ADRs). These both contribute to poor levels of adherence. Pharmacogenetics (PGx) considers how genetic variation can influence an individual’s response to a drug. Pharmacogenetic testing is a tool that could aid clinicians when selecting psychotropic medications, as part of a more personalized approach to prescribing. This may improve the use of and adherence to these medications. Yet to date, the implementation of PGx in mental health environments in the United Kingdom has been slow. This review aims to identify the current barriers and enablers to the implementation of PGx in psychiatry and determine how this can be applied to the uptake of PGx by NHS mental health providers. A systematic searching strategy was developed, and searches were carried out on the PsychInfo, EmBase, and PubMed databases, yielding 11 appropriate papers. Common barriers to the implementation of PGx included cost, concerns over incorporation into current workflow and a lack of knowledge about PGx; whilst frequent enablers included optimism that PGx could lead to precision medicine, reduce ADRs and become a more routine part of psychiatric clinical care. The uptake of PGx in psychiatric care settings in the NHS should consider and overcome these barriers, while looking to capitalize on the enablers identified in this review.
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Affiliation(s)
- Adam Jameson
- Bradford District Care NHS Foundation Trust, Bradford, United Kingdom.,School of Pharmacy and Medical Sciences, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Beth Fylan
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom.,Bradford Institute of Health Research, NIHR Yorkshire and Humber Patient Safety Translational Research Centre, Bradford, United Kingdom
| | - Greg C Bristow
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, United Kingdom
| | - Gurdeep S Sagoo
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.,National Institute for Health Research Leeds in vitro Diagnostics Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Caroline Dalton
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Alastair Cardno
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Jaspreet Sohal
- Bradford District Care NHS Foundation Trust, Bradford, United Kingdom
| | - Samantha L McLean
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
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13
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Pardiñas AF, Owen MJ, Walters JTR. Pharmacogenomics: A road ahead for precision medicine in psychiatry. Neuron 2021; 109:3914-3929. [PMID: 34619094 DOI: 10.1016/j.neuron.2021.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/05/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Psychiatric genomics is providing insights into the nature of psychiatric conditions that in time should identify new drug targets and improve patient care. Less attention has been paid to psychiatric pharmacogenomics research, despite its potential to deliver more rapid change in clinical practice and patient outcomes. The pharmacogenomics of treatment response encapsulates both pharmacokinetic ("what the body does to a drug") and pharmacodynamic ("what the drug does to the body") effects. Despite early optimism and substantial research in both these areas, they have to date made little impact on clinical management in psychiatry. A number of bottlenecks have hampered progress, including a lack of large-scale replication studies, inconsistencies in defining valid treatment outcomes across experiments, a failure to routinely incorporate adverse drug reactions and serum metabolite monitoring in study designs, and inadequate investment in the longitudinal data collections required to demonstrate clinical utility. Nonetheless, advances in genomics and health informatics present distinct opportunities for psychiatric pharmacogenomics to enter a new and productive phase of research discovery and translation.
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Affiliation(s)
- Antonio F Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Michael J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
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14
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Determeyer P, Crowder J, O'Mahony E, Esquivel B, Atwal H, Atwal PS, Rogers SL. Application of the community dialogues method to identify ethical values and priorities related to pharmacogenomics. Pharmacogenomics 2021; 22:693-701. [PMID: 34114883 DOI: 10.2217/pgs-2021-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Given the expansion of genetics in medicine, there is a growing need to develop approaches to engage patients in understanding how genetics affects their health. Various qualitative methods have been applied to gain a deeper understanding of patient perspectives in topics related to genetics. Community dialogues (CD) are a bi-directional research method that invites community members to discuss a pertinent, challenging topic over the course of a multi-week period and the community members openly discuss their positions on the topic. Authors discuss the first application of the CD method to the topic of pharmacogenetics testing. Additional CD are needed to engage diverse participant populations on this topic to improve genetics literacy, enhance physician engagement and drive policy change.
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Affiliation(s)
| | - Jerome Crowder
- College of Medicine, University of Houston, Houston, TX 77004, USA
| | | | | | - Herjot Atwal
- Genomic & Personalized Medicine, Atwal Clinic, Palm Beach, FL 33480, USA
| | - Paldeep S Atwal
- Genomic & Personalized Medicine, Atwal Clinic, Palm Beach, FL 33480, USA
| | - Sara L Rogers
- American Society of Pharmacovigilance, Houston, TX 77225, USA
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15
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Kastrinos A, Campbell-Salome G, Shelton S, Peterson EB, Bylund CL. PGx in psychiatry: Patients' knowledge, interest, and uncertainty management preferences in the context of pharmacogenomic testing. PATIENT EDUCATION AND COUNSELING 2021; 104:732-738. [PMID: 33414028 PMCID: PMC9620865 DOI: 10.1016/j.pec.2020.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/04/2020] [Accepted: 12/22/2020] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Pharmacogenomic testing (PGx) is expanding into psychiatric care. PGx could potentially offer a unique benefit to psychiatric patients, providing information about patients' reaction to medications that could reduce the time and financial burdens of drug optimization. The aims of this study were to: (1) examine psychiatry patients' familiarity and interest in PGx, and (2) explore how Uncertainty Management Theory relates to PGx testing in psychiatry. METHOD We surveyed psychiatric patients, measuring their PGx familiarity and interest, attitudes toward PGx testing, and preference for managing illness uncertainty. RESULTS We analyzed data from 598 patients. Patients' familiarity of PGx was low, but interest was high. Thirty percent of patients were familiar with the test from communication with their healthcare provider or their own online health information seeking. A preference for seeking information was a significant positive predictor of testing interest (p < .001). CONCLUSION Psychiatric patients were interested in PGx testing, regardless of their uncertainty management preferences. PRACTICE IMPLICATIONS This study is one of the first to examine psychiatric patients' perspectives on PGx testing in mental health care. Our findings show that psychiatric patients are interested in the test and are familiar enough with PGx to be included in future research on the topic.
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Affiliation(s)
- Amanda Kastrinos
- College of Journalism and Communications, University of Florida, Gainesville, United States.
| | - Gemme Campbell-Salome
- College of Journalism and Communications, University of Florida, Gainesville, United States
| | - Summer Shelton
- Department of Communication, Media, & Persuasion, Idaho State University, Pocatello, United States
| | | | - Carma L Bylund
- College of Journalism and Communications, University of Florida, Gainesville, United States
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