Introducing Personalized Health for the Family: The Experience of A Single Hospital System

Klein, Elisabeth; Fuller, Alma; Jo, Gun-Hee; Lawrence, Grace; Haga, Susanne B.

doi:10.2217/pgs-2017-0112

Cited by 9 publications

(3 citation statements)

References 18 publications

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“…The unique expertise of members of both professions is complementary to the skills and roles of other clinicians, such as physicians [68]. Given the complexity involved in implementing pharmacogenetic testing, and the diversity in skill sets and scopes of practice of healthcare professionals, multidisciplinary teams are ideal for providing optimal patient care [69,70,71].…”

Section: Overcoming Barriermentioning

confidence: 99%

Pharmacogenomic Testing: Clinical Evidence and Implementation Challenges

Hippman

Nislow

2019

JPM

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Pharmacogenomics can enhance patient care by enabling treatments tailored to genetic make-up and lowering risk of serious adverse events. As of June 2019, there are 132 pharmacogenomic dosing guidelines for 99 drugs and pharmacogenomic information is included in 309 medication labels. Recently, the technology for identifying individual-specific genetic variants (genotyping) has become more accessible. Next generation sequencing (NGS) is a cost-effective option for genotyping patients at many pharmacogenomic loci simultaneously, and guidelines for implementation of these data are available from organizations such as the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Dutch Pharmacogenetics Working Group (DPWG). NGS and related technologies are increasing knowledge in the research sphere, yet rates of genomic literacy remain low, resulting in a widening gap in knowledge translation to the patient. Multidisciplinary teams—including physicians, nurses, genetic counsellors, and pharmacists—will need to combine their expertise to deliver optimal pharmacogenomically-informed care.

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Section: Overcoming Barriermentioning

confidence: 99%

Pharmacogenomic Testing: Clinical Evidence and Implementation Challenges

Hippman

Nislow

2019

JPM

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“…Some programs have also been implemented at community health centers 94. PGx programs that are devoted exclusively to children include Medi-Map at the Inova Hospital Center in Fairfax, Virginia,95 Cincinnati Children’s Hospital Medical Center,96 and St Jude Children’s Hospital 97. In addition, other programs are investigating the benefits and risks of implementing newborn sequencing programs, in affected infants in neonatal intensive care units (NICU)98,99 and healthy newborns,100 though PGx genes are not typically included (e.g., the BabySeq program reported including SLCO1B1, associated with response to statins101).…”

Section: Pgx Programs In Childrenmentioning

confidence: 99%

<p>Pharmacogenomic Testing In Pediatrics: Navigating The Ethical, Social, And Legal Challenges</p>

Haga

2019

PGPM

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For the past several years, the implementation of pharmacogenetic (PGx) testing has become widespread in several centers and clinical practice settings. PGx testing may be ordered at the point-of-care when treatment is needed or in advance of treatment for future use. The potential benefits of PGx testing are not limited to adult patients, as children are increasingly using medications more often and at earlier ages. This review provides some background on the use of PGx testing in children as well as mothers (prenatally and post-natally) and discusses the challenges, benefits, and the ethical, legal, and social implications of providing PGx testing to children.

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“…Most analgesics are metabolized in the liver by the cytochrome P450 (CYP) drug-metabolizing enzymes [19]. Opioids undergo metabolism by CYP2D6 and CYP3A4 to either active or inactive metabolites, whereas most NSAIDs undergo metabolism by CYP2C9 to inactive metabolites [13,15,20]. The highly polymorphic nature of these genes, especially CYP2D6, contributes to altered pharmacokinetics or drug disposition.…”

Section: Introductionmentioning

confidence: 99%

Does Preoperative Pharmacogenomic Testing of Patients Undergoing TKA Improve Postoperative Pain? A Randomized Trial

Kraus,

Bingham,

Kekic

et al. 2023

Clin Orthop Relat Res

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Background Pharmacogenomics is an emerging and affordable tool that may improve postoperative pain control. One challenge to successful pain control is the large interindividual variability among analgesics in their efficacy and adverse drug events. Whether preoperative pharmacogenomic testing is worthwhile for patients undergoing TKA is unclear. Questions/purposes (1) Are the results of preoperative pharmacogenetic testing associated with lower postoperative pain scores as measured by the Overall Benefit of Analgesic Score (OBAS)? (2) Do the results of preoperative pharmacogenomic testing lead to less total opioids given? (3) Do the results of preoperative pharmacogenomic testing lead to changes in opioid prescribing patterns? Methods Participants of this randomized trial were enrolled from September 2018 through December 2021 if they were aged 18 to 80 years and were undergoing primary TKA under general anesthesia. Patients were excluded if they had chronic kidney disease, a history of chronic pain or narcotic use before surgery, or if they were undergoing robotic surgery. Preoperatively, patients completed pharmacogenomic testing (RightMed, OneOME) and a questionnaire and were randomly assigned to the experimental group or control group. Of 99 patients screened, 23 were excluded, one before randomization; 11 allocated patients in each group did not receive their allocated interventions for reasons such as surgery canceled, patients ultimately undergoing spinal anesthesia, and change in surgery plan. Another four patients in each group were excluded from the analysis because they were missing an OBAS report. This left 30 patients for analysis in the control group and 38 patients in the experimental group. The control and experimental groups were similar in age, gender, and race. Pharmacogenomic test results for patients in the experimental group were reviewed before surgery by a pharmacist, who recommended perioperative medications to the clinical team. A pharmacist also assessed for clinically relevant drug-gene interactions and recommended drug and dose selection according to guidelines from the Clinical Pharmacogenomics Implementation Consortium for each patient enrolled in the study. Patients were unaware of their pharmacogenomic results. Pharmacogenomic test results for patients in the control group were not reviewed before surgery; instead, standard perioperative medications were administered in adherence to our institutional care pathways. The OBAS (maximum 28 points) was the primary outcome measure, recorded 24 hours postoperatively. A two-sample t-test was used to compare the mean OBAS between groups. Secondary measures were the mean 24-hour pain score, total morphine milligram equivalent, and frequency of opioid use. Postoperatively, patients were assessed for pain with a VAS (range 0 to 10). Opioid use was recorded preoperatively, intraoperatively, in the postanesthesia care unit, and 24 hours after discharge from the postanesthesia care unit. Changes in perioperative opioid use based on pharmacogenomic testing were recorded, as were changes in prescription patterns for postoperative pain control. Preoperative characteristics were also compared between patients with and without various phenotypes ascertained from pharmacogenomic test results. Results The mean OBAS did not differ between groups (mean ± SD 4.7 ± 3.7 in the control group versus 4.2 ± 2.8 in the experimental group, mean difference 0.5 [95% CI -1.1 to 2.1]; p = 0.55). Total opioids given did not differ between groups or at any single perioperative timepoint (preoperative, intraoperative, or postoperative). We found no difference in opioid prescribing pattern. After adjusting for multiple comparisons, no difference was observed between the treatment and control groups in tramadol use (41% versus 71%, proportion difference 0.29 [95% CI 0.05 to 0.53]; nominal p = 0.02; adjusted p > 0.99). Conclusion Routine use of pharmacogenomic testing for patients undergoing TKA did not lead to better pain control or decreased opioid consumption. Future studies might focus on at-risk populations, such as patients with chronic pain or those undergoing complex, painful surgical procedures, to test whether pharmacogenomic results might be beneficial in certain circumstances. Level of Evidence Level I, therapeutic study.

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Introducing Personalized Health for the Family: The Experience of A Single Hospital System

Cited by 9 publications

References 18 publications

Pharmacogenomic Testing: Clinical Evidence and Implementation Challenges

Pharmacogenomic Testing: Clinical Evidence and Implementation Challenges

<p>Pharmacogenomic Testing In Pediatrics: Navigating The Ethical, Social, And Legal Challenges</p>

Does Preoperative Pharmacogenomic Testing of Patients Undergoing TKA Improve Postoperative Pain? A Randomized Trial

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