by Konstantinos Lazaridis, M.D., Assistant Director, Mayo Clinic Center for Individualized Medicine
Perhaps more so than other areas, the emerging field of preemptive pharmacogenomics holds enormous promise to immediately improve the medical care of our patients. Patients would save time, money and untold suffering if they proactively had DNA testing to match medications to their individual genetic profiles. It is also important to integrate those test results into the patient’s electronic health record so they are available at the moment physicians are prescribing therapies.
Pharmacogenomics testing is currently one of the most promising tools in personalized medicine because of the potential widespread impact. The RIGHT study, done at Mayo Clinic, indicates nearly all patients could benefit. The study found that 99.9 percent of participants studied had a genetic variant that impacted the way their bodies processed medications. Conditions that hold the most promise for pharmacogenomics include:
- Pain and psychiatric treatment — identifying medications that balance effectiveness with side effects.
- Transplants — immunosuppressants keep the body from rejecting a transplanted organ, but leave patients vulnerable to infection.
- Patients with polypharmacy — taking several medications often means that a drug is not working. Pharmacogenomics testing can identify what drugs do not work and simplify medical therapy.
Finding the Most Effective Medication
It is likely not uncommon for patients with a chronic medical condition to be on a “therapeutic odyssey,” a term we’ve coined to describe the frustrations patients experience when they try medication after medication for years without getting any relief from the symptoms of their conditions. I further explain this phenomenon in Improving Therapeutic Odyssey: Preemptive Pharmacogenomics Utility in Patient Care, an editorial that appeared in the October 23, 2016 edition of The Journal of Clinical Pharmacology & Therapeutics.
Therapeutic odyssey represents a protracted journey in a patient’s quest to find effective therapy for a chronic disease, often leading to unsuccessful treatments, frequent visits to health care providers, poly-pharmacy, herbal or alternative medicine-based therapy options, and sometimes unwanted symptoms – or even adverse drug events. In fact, the Centers for Disease Control, in a study published in Journal of the American Medical Association (JAMA), reports one out of every 250 Americans visited the emergency room because of a harmful drug reaction in both 2013 and 2014. Now is the time for health care providers to proactively recommend pharmacogenomics testing for all patients and enter the results in the electronic health record in order to find the most effective medications.
Mayo Clinic has created 19 drug-gene rules that are embedded in the electronic health record, notifying prescribers when a genetic variation may have a harmful drug interaction. Those alerts in the electronic health record have prevented more than 10,000 drug reactions at Mayo Clinic since 2013.
Pharmacogenomics testing must become a standard practice in order to improve the safety and quality of care. Doctors, pharmacists, nurses and educators must all work together to adopt practices that make it possible for all patients to benefit from the individually tailored treatments that pharmacogenomics offers.
Dr. Lazaridis is the Everett J. and Jane M. Hauck Associate Director in Minnesota. He is also recognized as the William O. Lund, Jr., and Natalie C. Lund Director, Clinomics Program.