From common medical procedures to treating children, pharmacists have played a key role in using pharmacogenomics to deliver the best care possible.
After suffering a heart attack in 2014, Pat Peters needed a percutaneous coronary intervention (PCI) – a procedure that many Americans undergo each year. However, unlike most other patients, Peters was lucky to have a seasoned genetic counselor and pharmacogenomics advocate by his side.
“When my dad’s physician placed an order for clopidogrel as antiplatelet therapy, I knew from a pharmacogenomics test that he was one of the [small number] of the population that are CYP2C19 poor metabolizers, so clopidogrel would have been ineffective for him,” said Pat’s daughter, Trish Brown, who is director of AMR Payer Partnerships and Field Market Access at Illumina, a genetic sequencing company based in San Diego.
With over 20 years of experience in the genomics industry, Brown knew pharmacogenomics could immensely improve treatment decisions and improve the likelihood a drug will be safe and effective. When Brown informed the physician of her father’s CYP2C19 status, “thankfully, the cardiologist accepted the genomic results and chose an alternative agent,” Brown said.
For the past 30 years, pharmacists at St. Jude Children’s Research Hospital in Memphis, Tennessee, have been incorporating pharmacogenomics results to help physicians make the best treatment decisions possible.
Mary Relling, Pharm.D., holds an endowed chair in the Department of Pharmacy and Pharmaceutical Sciences at the hospital. Pharmacists leading the PG4KDS program have tested for hundreds of gene variants and used those genetic data to improve medication efficacy and safety outcomes. They have so far enrolled nearly 6,000 patients and implemented 14 genes affecting 66 drugs, Dr. Relling said.
Incorporating Findings in the EHR
At the University of Alabama at Birmingham School of Medicine, Nita Limdi, Pharm.D., Ph.D., MSPH, director of the program for translational pharmacogenomics and associate director of the Hugh Kaul Precision Medicine Institute, and her colleagues are developing a “genomic medicine landing page” in their EHR, where pharmacogenomic results and recommendations will be housed.
In another effort to increase the use of pharmacogenomics at her institution, Dr. Limdi is building a team of specialized pharmacogenomics pharmacists who will lead testing efforts at her hospital.
“The idea is to have our pharmacogenomics service line start by doing all the initial genotype interpretation and consults, but as they hand off those results to clinical pharmacists embedded in different units, they will also shepherd them so they can be proficient in interpreting results on their own,” said Dr. Limdi.
By David Wild