This Month in Pharmacogenomics
Check out this blog post from our partners at YouScript, Inc., providers of the only medication management system that enables individualized, gene-based prescribing at the point of care.
While we here at YouScript are in the business of promoting our business, and the benefits of PGx, and the importance of being able to make those results actionable for patients and providers with the YouScript Clinical Decision Tool, we also care very much about the promotion of PGx as a whole. And with our many social media platforms, YouScript Facebook, Genelex Facebook, YouScript Twitter, Genelex Twitter, and Pinterest, daily, we’re scouring the web, looking for articles and opinions highlighting the benefits of Pharmacogenomics and Precision medicine. If you’re looking for something to read to further your knowledge about the world of Pharmacogenomics, here’s a primer for important, recent, trending, PGx articles from around the web:
America’s other drug problem: Giving the elderly too many prescriptions –Anna Gorman, Washington Post
"An increasing number of elderly patients nationwide are on multiple medications to treat chronic diseases, raising their chances of dangerous drug interactions and serious side effects. Often the drugs are prescribed by different specialists who don’t communicate with each other. If those patients are hospitalized, doctors making the rounds add to the list — and some of the drugs they prescribe may be unnecessary or unsuitable."
However, up to 99 percent of us may have small variations in our genes that can also impact how we react to common medications, including pain relievers, antidepressants and blood thinners.
Now, through a new kind of genetic testing in a field known as pharmacogenomics, some doctors are able to identify a number of these variations to help predict how their patients might respond to a new medication.
These tests are very different than genome sequencing services that provide data on your ancestry, analysis of disease-related genes or information on your risk of developing certain diseases. Instead, the tests look for specific gene variants that can help physicians minimize the trial and error of prescribing certain medications and help narrow down medication choices, especially when it comes to treatments for pain and psychiatric medications."
"As many as 10 percent of people do not receive pain relief from opioids. That’s a staggering statistic in a country where more than 75 million people live with chronic pain. Many individuals, like Cirrincione, who don’t respond to certain prescription pain relievers have no idea why. But a type of genetic testing is bringing answers to a growing number of them."
"Pharmacogenomics can help create a new model of psychiatric practice that is genetically informed, neurobiologically empowered, and data oriented,” Stephen Stahl, M.D., Ph.D., told a packed room at APA’s Annual Meeting in Atlanta. Stahl, who is a professor of psychiatry at the University of California, San Diego, was the recipient of the 2016 David A. Mrazek Memorial Award, which honors the contributions of clinicians in the field of pharmacogenomics..."Genes don’t code for psychiatric disorders or symptoms, just for proteins and epigenetic regulators,” he said, noting that about 20 single-nucleotide polymorphisms have been studied in depression, but each has only a small effect. “We will have to look at a portfolio of genes, not just one, to better diagnose and treat patients.”
"Dr. El-Sohemy suspected that the relationship between coffee and heart disease might also vary from one individual to the next. And he zeroed in on one gene in particular, CYP1A2, which controls an enzyme – also called CYP1A2 – that determines how quickly our bodies break down caffeine.
One variant of the gene causes the liver to metabolize caffeine very quickly. People who inherit two copies of the “fast” variant – one from each parent – are generally referred to as fast metabolizers. Their bodies metabolize caffeine about four times more quickly than people who inherit one or more copies of the slow variant of the gene. These people are called slow metabolizers."
"The proportion of elderly patients concurrently using five or more prescription medications increased from 30.6% to 35.8% between 2005-2006 and 2010-2011, new data show..
These findings suggest that the unsafe use of multiple medications among older adults is a growing public health problem. Therefore, health care professionals should carefully consider the adverse effects of commonly used prescription and nonprescription medication combinations when treating older adults and counsel patients about these risks."
"The increase in people using multiple medications - known as polypharmacy - paralleled an increase in the number of older Americans at risk for major drug interactions, researchers found.
"That’s a concern from a public health standpoint, because it’s getting worse," said Dima Qato, the study's lead author from the University of Illinois at Chicago.
Qato and her colleagues previously reported that polypharmacy is common among older Americans. More than half were taking prescription and nonprescription medications between 2005 and 2006."
"Doctors are not accustomed to making medication choices using genetics. What they have done, for decades, is to look at easily observed factors such as a patient’s age and weight and kidney or liver functions. They also considered what other medications a patient is taking and any personal preferences.
If clinicians would consider genetics, here is what they could learn about prescribing the common painkiller codeine. Typically, the body produces an enzyme called CYP2D6 that breaks down the drug into its active ingredient, morphine, which provides pain relief. Yet as many as 10 percent of patients have genetic variants that produce too little of the enzyme, so almost no codeine gets turned into morphine. These people get little or no help for their pain. About 2 percent of the population has the reverse problem. They have too many copies of the gene that produces the enzyme, leading to overproduction. For them, a little codeine can quickly turn into too much morphine, which can lead to a fatal overdose."
"The efficacy of any given drug therapy is dependent on a number of factors, most commonly described through the pharmacokinetic parameters of absorption, distribution, metabolism, and elimination (ADME). Together, these factors determine whether a patient will need increased or decreased dosages, or whether a given therapy will work at all in that patient. Additionally, these factors can determine drug-drug interactions for patients on polypharmacy."
"Geriatricians and researchers have warned for years about the potential hazards of polypharmacy, usually defined as taking five or more drugs concurrently. Yet it continues to rise in all age groups, reaching disturbingly high levels among older adults.
“It’s as perennial as the grass,” Dr. Alexander said. “The average senior is taking more medicines than ever before.”
Tracking prescription drug use from 1999 to 2012 through a large national survey, Harvard researchers reported in November that 39 percent of those over age 65 now use five or more medications — a 70 percent increase in polypharmacy over 12 years."
"How people’s genes affect their response to medications is called pharmacogenetics. One of the first such drug-gene interactions was identified at the Mayo Clinic in Rochester, Minn., in the 1970s. Researchers discovered that about 1 in 300 children being treated for childhood leukemia had a gene variation that made the drug thiopurine destroy their bone marrow. Now, children are routinely tested before undergoing treatment with the drug....
Genelex Corp., in Seattle, says its YouScript software program analyzes how multiple medications, over-the-counter drugs and supplements react with each other and with patients’ DNA. The testing and analysis costs roughly $1,000. “Your results don’t change; you’ll have that information the rest of your life,” says Genelex Chief Executive Kristine Ashcraft."
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