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Effects of Pharmacogenomic Testing in Clinical Pain Management: Retrospective Study

BACKGROUND: The availability of pharmacogenomic (PGx) methods to determine the right drug and dosage for individualized patient treatment has increased over the past decade. Adoption of the resulting PGx reports in a clinical setting and monitoring of clinical outcomes is a challenging and long-term...

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Autores principales: Tagwerker, Christian, Carias-Marines, Mary Jane, Smith, David J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414297/
https://www.ncbi.nlm.nih.gov/pubmed/37725552
http://dx.doi.org/10.2196/32902
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author Tagwerker, Christian
Carias-Marines, Mary Jane
Smith, David J
author_facet Tagwerker, Christian
Carias-Marines, Mary Jane
Smith, David J
author_sort Tagwerker, Christian
collection PubMed
description BACKGROUND: The availability of pharmacogenomic (PGx) methods to determine the right drug and dosage for individualized patient treatment has increased over the past decade. Adoption of the resulting PGx reports in a clinical setting and monitoring of clinical outcomes is a challenging and long-term commitment. OBJECTIVE: This study summarizes an extended PGx deep sequencing panel intended for medication dosing and prescription guidance newly adopted in a pain management clinic. The primary outcome of this retrospective study reports the number of cases and types of drugs covered, for which PGx data appears to have assisted in optimal drug prescription and dosing. METHODS: A PGx panel is described, encompassing 23 genes and 141 single-nucleotide polymorphisms or indels, combined with PGx dosing guidance and drug-gene interaction (DGI) and drug-drug interaction (DDI) reporting to prevent adverse drug reactions (ADRs). During a 2-year period, patients (N=171) were monitored in a pain management clinic. Urine toxicology, PGx reports, and progress notes were studied retrospectively for changes in prescription regimens before and after the PGx report was made available to the provider. An additional algorithm provided DGIs and DDIs to prevent ADRs. RESULTS: Among patient PGx reports with medication lists provided (n=146), 57.5% (n=84) showed one or more moderate and 5.5% (n=8) at least one serious PGx interaction. A total of 96 (65.8%) patients showed at least one moderate and 15.1% (n=22) one or more serious DGIs or DDIs. A significant number of active changes in prescriptions based on the 102 PGx/DGI/DDI report results provided was observed for 85 (83.3%) patients for which a specific drug was either discontinued or switched within the defined drug classes of the report, or a new drug was added. CONCLUSIONS: Preventative action was observed for all serious interactions, and only moderate interactions were tolerated for the lack of other alternatives. This study demonstrates the application of an extended PGx panel combined with a customized informational report to prevent ADRs and improve patient care.
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spelling pubmed-104142972023-09-12 Effects of Pharmacogenomic Testing in Clinical Pain Management: Retrospective Study Tagwerker, Christian Carias-Marines, Mary Jane Smith, David J JMIRx Med Original Paper BACKGROUND: The availability of pharmacogenomic (PGx) methods to determine the right drug and dosage for individualized patient treatment has increased over the past decade. Adoption of the resulting PGx reports in a clinical setting and monitoring of clinical outcomes is a challenging and long-term commitment. OBJECTIVE: This study summarizes an extended PGx deep sequencing panel intended for medication dosing and prescription guidance newly adopted in a pain management clinic. The primary outcome of this retrospective study reports the number of cases and types of drugs covered, for which PGx data appears to have assisted in optimal drug prescription and dosing. METHODS: A PGx panel is described, encompassing 23 genes and 141 single-nucleotide polymorphisms or indels, combined with PGx dosing guidance and drug-gene interaction (DGI) and drug-drug interaction (DDI) reporting to prevent adverse drug reactions (ADRs). During a 2-year period, patients (N=171) were monitored in a pain management clinic. Urine toxicology, PGx reports, and progress notes were studied retrospectively for changes in prescription regimens before and after the PGx report was made available to the provider. An additional algorithm provided DGIs and DDIs to prevent ADRs. RESULTS: Among patient PGx reports with medication lists provided (n=146), 57.5% (n=84) showed one or more moderate and 5.5% (n=8) at least one serious PGx interaction. A total of 96 (65.8%) patients showed at least one moderate and 15.1% (n=22) one or more serious DGIs or DDIs. A significant number of active changes in prescriptions based on the 102 PGx/DGI/DDI report results provided was observed for 85 (83.3%) patients for which a specific drug was either discontinued or switched within the defined drug classes of the report, or a new drug was added. CONCLUSIONS: Preventative action was observed for all serious interactions, and only moderate interactions were tolerated for the lack of other alternatives. This study demonstrates the application of an extended PGx panel combined with a customized informational report to prevent ADRs and improve patient care. JMIR Publications 2022-05-03 /pmc/articles/PMC10414297/ /pubmed/37725552 http://dx.doi.org/10.2196/32902 Text en ©Christian Tagwerker, Mary Jane Carias-Marines, David J Smith. Originally published in JMIRx Med (https://med.jmirx.org), 03.05.2022. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIRx Med, is properly cited. The complete bibliographic information, a link to the original publication on https://med.jmirx.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Tagwerker, Christian
Carias-Marines, Mary Jane
Smith, David J
Effects of Pharmacogenomic Testing in Clinical Pain Management: Retrospective Study
title Effects of Pharmacogenomic Testing in Clinical Pain Management: Retrospective Study
title_full Effects of Pharmacogenomic Testing in Clinical Pain Management: Retrospective Study
title_fullStr Effects of Pharmacogenomic Testing in Clinical Pain Management: Retrospective Study
title_full_unstemmed Effects of Pharmacogenomic Testing in Clinical Pain Management: Retrospective Study
title_short Effects of Pharmacogenomic Testing in Clinical Pain Management: Retrospective Study
title_sort effects of pharmacogenomic testing in clinical pain management: retrospective study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414297/
https://www.ncbi.nlm.nih.gov/pubmed/37725552
http://dx.doi.org/10.2196/32902
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