Pharmacogenomics – The New Standard of Care
For the past decade, we’ve been hearing about how pharmacogenomics, using a patient’s genetic information to more precisely prescribe medications, is the future of medicine and will one day be the standard of care. For many medications, the science supporting the use of pharmacogenetics is clear, but widespread adoption will only transpire when this technology is covered by insurers (they are starting to), or by the provincial payers in Canada (they are looking at it), or by the Centers for Medicare & Medicaid Services (CMS), in the U.S. (they do cover pharmacogenetics in some cases). With payers finally understanding the potential impact of this technology, both in improving health outcomes as well as in reducing healthcare costs, I think that we’re finally seeing pharmacogenetics become the standard of care. With the speed at which healthcare technologies are brought from the lab bench to the clinic, we may still be a number of years away, but I think we’re finally getting close – a guy can dream, right?
So many people we speak with have stories of how themselves or their loved ones had experienced the one-size-fits-all and lengthy trial-and-error odyssey that many people go through when they’re first prescribed a medication. Pharmacogenomics (PGx) is a field of “personalized” or “precision” medicine, that aims to provide evidence-based drug and dosing recommendations based on a patient’s genetic make-up. PGx testing can be thought of as “drug-compatibility” testing which looks at how your liver metabolizes medications by analyzing the genes encoding a set of enzymes whose roles in drug metabolism have been very well established. The concept is simple… if you metabolize a medication too quickly, it flows through your system so fast that it doesn’t have the chance to accumulate to therapeutic levels, so it just doesn’t work. If you metabolize a drug too slowly, it can build up in your system to toxic levels (especially if you take additional doses over the next few days), and can cause unwanted side effects. The genes that encode the liver enzymes that metabolize medications are so well characterized that there are now peer-reviewed, practice guidelines that provide drug/dosing recommendations for prescribers so that they can give their patients the right drug at the right dose based on what genetic variants they have. Simple right? So why isn’t this standard of care?
While PGx testing can be helpful for a broad array of therapeutic areas including cardiovascular, gastroenterology, rheumatology, pain, oncology and many others, perhaps the biggest impact area for PGx is for mental health. Many mental health drugs are notoriously difficult to dose correctly, and prescribers will often anticipate that their patient will fail on the first attempt and have to come back for dose adjustments or to try alternative medications. This trial-and-error process can oftentimes be quite lengthy, especially for antidepressants and antianxiety medications which can take several weeks to either start to work or until you find out that it doesn’t work, another several weeks to detox or wash out the first drug, and then another several weeks to know if the second medication attempted will work. Only about one-third of depressed individuals are lucky enough to find a drug that works for them on the first attempt. The majority of patients must go through the trial-and-error process to get stabilized. Some may feel an improvement, but are unable to tolerate the side effects; others won’t receive any benefit at all. As a result, patients try multiple medications, varying doses, and even end up taking a combination of different drugs, and this process can take several months or even years. PGx testing can help predict which medications will work, and in many cases at what dose, the first time, thereby significantly minimizing this trial-and-error odyssey that patients often have to endure.
We launched our MatchMyMeds™ pharmacogenetics test just over 5 years ago, and since that time, we have heard several success stories, have contributed to some exciting research projects, and have received some great testimonials from our clients (see below). It’s an exciting time for personalized medicine as PGx testing is now finally becoming the standard of care.
“Pharmacogenomic testing is going to become standard of practice in patient-centered care — the DNALabs reporting system will be a game changer in terms of adoption especially for physicians who have not had intensive training on interpreting genetic test results.”
-Internal Medicine Specialist
“… example of one client who was on a few different psychotropics with symptoms including headaches. They got the DNA report back, noticed he was on a “red” medication, switched it, and his headaches abated. He’s now doing much better on his regimen.”
-From a Psychiatrist in a study involving the Canadian Armed Forces
“Thanks to you guys I actually have steadfast proof for pain med help. Trying to explain to doctors that you’re in excruciating pain when they’ve already administered drugs that work on most people. This test is changing my life.”
“Thank you very much for providing this service. My initial look at medications in which I have adverse effects is exactly matched on the test results! This will be so helpful in choosing medications moving forward.”
Dr. Aaron Goldman, PhD
Chief Science Officer