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Transcript of Implementing pharmacogenetics with CIPHER™ Personalized Medicine Program Property of PGxl...
Implementing pharmacogenetics with CIPHER™
Personalized Medicine Program
Property of PGxl Laboratories
Kristen K. Reynolds, PhDVP Laboratory Operations11-20-14
Polypharmacy
Diabetes
Hyperlipidemia
Coronary Artery Disease
HypertensionThrombosisStroke
Depression
Psychosis
ADHD
Arrhythmia
ChronicPain
CIPHER manages the whole patient
Property of PGxl Laboratories
CIPHER interpretive support: Drug-Gene Pilot• Enhanced interpretive report format incorporating patient’s current med list
Drug-Drug InteractionsDRUG-DRUG INTERACTIONS:
ASPIRIN- PAROXETINE may result in an increased risk of bleeding.
ASPIRIN- CARVEDILOL or FUROSEMIDE may result in decreased diuretic and/or antihypertensive efficacy.
ASPIRIN- LOSARTAN may result in decreased antihypertensive effects and an increased risk of renal impairment.
CARVEDILOL- CLONIDINE result in increased risk of sinus bradycardia; exaggerated clonidine withdrawal response (acute hypertension).
LEVOTHYROXINE- PAROXETINE may result in increased levothyroxine requirements.
Property of PGxl Laboratories
Medications not metabolized or otherwise not accounted for in current genetic testing profile:ASPIRINCARBIDOPA/LEVODOPACLONIDINE CLOTRIMAZOLEFUROSEMIDELEVOTHYROXINELYRICASULFASALAZINE
Drug-Gene Pilot Stats (Feb-Sept 2014)General Cohort StatisticsPhysicians participating (GP, psychiatry, cardiology, pain management, gerontology)
27
Patients included (Feb-Sept 2014) 703
Total medications 8090Total drug-drug interactions found (excluding minor) 3113
Total meds with a genetic link 2955psychotropics 28%
cardiovascular 32%analgesics 20%
Other (allergy/asthma, cough, nausea, etc) 20%Avg number meds/patient 12Avg meds/patient with a genetic link 4
44% of medications with a potential gene link had a variant genotype identifying a Drug-Gene Conflict
Minor Moderate Major Contraindicated0
10
20
30
40
50
60
13%
52%
20%15%
% o
f med
icat
ions
wit
h co
nfli
ct
87%
PRODRUG OPIOIDS
43%
43% of opioids had CYP2D6 contraindication
SSRI ANTIDEPRESSANTS
single gene conflict
CYP and SLC6A4 conflict
40%
47%
87% of SSRIs had one or more gene conflicts
CARDIOVASCULAR MEDICATIONS
Statins
Losartan
Beta-blockers
Warfarin
Clopidogrel
0 10 20 30 40 50 60 70 80
Rosuvastatin 18% Simvastatin 23%
33%
49%
35%
63%
Atorvastatin 43%
% of medications with gene conflict
Drug-Gene Pilot feedback surveysQuestions(511 patients to date)
% of the cases
General comments
Overall % of patients for whom decisions changed based on report
52% • User friendly; easier to understand; like the colored symbols and alternative meds to consider
• Useful antidepressants, antipsychotics, anticoagulants, opioids
• “Drug-drug interactions were an eye-opening experience”
• “Overall reduction in total Rx meds was significant, 15-25%”
Used drug-drug interaction section 65%Switched a medication 57.5%Added or D/C medication without switch
50%
Avoided an entire class 52.5%Focused on an entire class 47.5%Adjusted dose of current medication 50%Made no regimen changes at all 45%Saw improvements in outcomes and/or patient satisfaction
67.5%
Summary• Many factors influence drug safety and efficacy
• CIPHER identifies significant risks across medication classes
• Genotyping a patient for a single indication, drug, or gene is unlikely to reveal the patient’s true risk burden based on their co-morbidities and polypharmacy
• Panel-based approach with drug-gene and drug-drug interactions improves sensitivity
– ID high-risk drugs, safer doses and/or better alternatives– different decisions 52% of the time resulting in improved outcomes and
satisfaction in 67% of cases
Do you have 1 or of these goals?
What is the cost of not havingPersonalized Medicine Program?
What are initiatives are you pursuing to reach these goals?
What would success look like for each of these goals?
What would achieving 1 or more of these goals mean?
Personalized Medicine Program Outcome Goals
Reduce Risk of ADRs
Reduce Cost of ADRs
Improve odds of reaching
therapeutic goals
Reach therapeutic goals
faster
Improve patient adherence to prescribers instructions
Improve patient satisfaction
Reduce regulatory
and/or legal risk
Innovative, Center of
Excellence
Decrease LOS
Decrease readmissions
Thank you!