Category Archives: Pharmacogenomics

Much research is underway to understand how genomic information can be used to develop more personalized and cost-effective strategies for using drugs to improve human health.

In 2007, the FDA revised the label on the common blood-thinning drug warfarin (Coumadin) to explain that a person's genetic makeup might influence response to the drug. Some doctors have since begun using genetic information to adjust warfarin dosage. Still, more research is needed to conclusively determine whether warfarin dosing that includes genetic information is better than the current trial-and-error approach.

The FDA also is considering genetic testing for another blood-thinner, clopidogrel bisulfate (Plavix), used to prevent dangerous blood clots. Researchers have found that Plavix may not work well in people with a certain genetic variant.

Cancer is another very active area of pharmacogenomic research. Studies have found that the chemotherapy drugs, gefitinib (Iressa) and erlotinib (Tarceva), work much better in lung cancer patients whose tumors have a certain genetic change. On the other hand, research has shown that the chemotherapy drugs cetuximab (Erbitux) and panitumumab (Vecitibix) do not work very well in the 40 percent of colon cancer patients whose tumors have a particular genetic change.

Pharmacogenomics may also help to quickly identify the best drugs to treat people with certain mental health disorders. For example, while some patients with depression respond to the first drug they are given, many do not, and doctors have to try another drug. Because each drug takes weeks to take its full effect, patients' depression may grow worse during the time spent searching for a drug that helps.

Recently, researchers identified genetic variations that influence the response of depressed people to citalopram (Celexa), which belongs to a widely used class of antidepressant drugs called selective serotonin re-uptake inhibitors (SSRIs). Clinical trials are now underway to learn whether genetic tests that predict SSRI response can improve patients' outcomes.

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Pharmacogenomics FAQ | NHGRI

Quest Diagnostics offers one of the most comprehensive pharmacogenomics test panels available to help you gain insight into a patients potential response to medications and optimize their treatment considerations and outcomes. This includes information for over 280 drugs across 44 genes*. This full panel is particularly advantageous for patients on multiple medications who may otherwise require multiple panelsall at a low cost and coming from a company you trust to meet all of your lab needs.

The Pharmacogenomics Panel from Quest provides pharmacogenetic information for 44 genes, and reports information across multiple classes of medications:

Physicians receive test results in a comprehensive and easy to understand report that may include dosing guidelines from CPIC, FDA-approved labeling, and other pharmacogenomic consortia. Results can be utilized as a reference for your patients throughout their lifetime.

Order Pharmacogenomics PGx panel today.

The Quest Diagnostics Pharmacogenomics Panel is based on pertinent literature sources that may provide clinical insights to help inform treating physicians about a patients genetic attributes to help optimize patient treatment considerations and outcomes.**

Pharmacogenetics/pharmacogenomics is the study of how inherited genetic differences impact the way drugs or medications affect a person. These genetic differences can impact the way a drug is absorbed or metabolized and thereby influence drug response. Pharmacogenomic tests may provide information about a persons genetic makeup to help doctors decide which medications and doses might work best for him or her. Pharmacogenomic testing can also help reduce the time and costs associated with a trial-and-error approach to treatment.1

Avoiding adverse drug reactions can make a difference

The Quest Diagnostics comprehensive pharmacogenomics test panel (PGx) offers insights into patient potential responses to different medications and over 280 drugs.*

The panel may determine:

A Pharmacogenomics Panel may provide additional insights to:

*Pharmacogenomic information is not assessed for potential alternative medications. These data are provided as alternatives to consider based on information reported in the literature due to pharmacogenomic contraindications in other medications.

**Sources available upon request.

DNA will be extracted from the sample and tested for changes in multiple genes.

***The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

Download PGx brochure.

Download PGx medication and gene list.

Download PGx Report guide.

Download Patient informed consent form.

Ordering steps

****Get copies of the paper Pharmacogenomics requisition from your Quest Diagnostics account manager.

The information provided herein and in the pharmacogenetics report is for physician consideration and each physician has to determine what is the best treatment for their patient based upon the physicians education, experience, and clinical assessment of the patient.

References

Link:
Quest Diagnostics : Pharmacogenomics

Overview Overview

The Center for Personalized Genetic Healthcare (CPGH) offers comprehensive pharmacogenomics services to individuals who are not responding to medication regimens or who are experiencing adverse side effects.

CPGH offers pharmacogenomics counseling, which can be incorporated into your medical care.

Prior to requesting an appointment, you will need to obtain a referral from your physician. If you are a patient outside the Cleveland Clinic health system, please have your physician complete a referral form and fax to 216.445.6935. To learn more about how to prepare for your appointment, review the "Before Your Visit" tab.

The Center for Personalized Genetic Healthcare (CPGH) is committed to providing comprehensive clinical genetic services, education and support to patients and family members. Our team of genetic experts will work with other Cleveland Clinic primary care providers and specialists to personalize your care by incorporating your genetic information into your overall health care plan.

You should consider having a pharmacogenomic evaluation if you have a personal history or have concerns about the following:

Contact your primary care provider or the Center for Personalized Genetic Healthcare (CPGH) to discuss whether a pharmacogenomics consultation is appropriate for you.

Prior to requesting an appointment, you will need to obtain a physician referral. If you are a patient outside the Cleveland Clinic health system, please have your physician complete a referral form and fax to 216.445.6935.

If you are a patient outside the Cleveland Clinic health system, you should send an authorization for the release of medical records form to each external facility. You may arrange to have medical records faxed (30 pages or less) to our department at 216.445.6935 or sent postal mail.

Cleveland Clinic Center for Personalized Genetic Healthcare Attn: Pharmacogenomics Clinic 9500 Euclid Ave. NE50 Cleveland, OH 44195

To make the most out of your visit, you should gather medication and health history information prior to your appointment. It may be helpful for you to prepare a list of current and past medications. Specifically, you will want to consider the following:

We will provide personalized expert counseling and education to you and your family. During your visit, you will see a genetics expert (clinical geneticist) and a pharmacogenomics clinical specialist for a genetics evaluation. You may also be scheduled with other Cleveland Clinic providers during your visit depending on your medical needs and physician availability.

After your visit, it may take anywhere from a few days up to two weeks for your clinical appointment notes to reach the healthcare providers that you requested to receive a copy. We are also glad to communicate with your healthcare providers about your case as needed. You are always welcome to follow up with us with questions regarding your visit.

Genetics consult and testing are billed as two separate services.

If genetic testing is indicated, your genetics provider will discuss costs and insurance coverage during your appointment.

Some patients are concerned that their genetic information may be used against them. To learn about your patient rights and protections in place to prevent genetic discrimination, read this article on GINA.

To learn more about billing options and financial assistance, review our billing and insurance information.

Prior to requesting an appointment, you will need to obtain a referral from your physician. If you are a patient outside the Cleveland Clinic health system, please have your physician complete a referral form and fax to 216.445.6935. To learn more about how to prepare for your appointment, review the "Before Your Visit" tab.

To schedule an appointment, please call 216.636.1768 or 800.998.4785.

T Building - Center for Personalized Genetic Healthcare9204 Euclid Ave.Cleveland , OH 44195

Link:
Pharmacogenomics | Cleveland Clinic

Pharmacogenomics, or the study of how genetics affect your bodys response to medications, is a relatively new and exciting field of science. Scientists are learning more each day about how genetic testing can be used to select the best medication for patients. Genetic testing can help a doctor determine whether a medication will be effective for a patient and provide dosing guidance. It can also help alert clincians to medications that might be potentially harmful to patients.

Genetic testing has become increasingly popular among doctors who prescribe psychiatric medication, in particular antidepressants. Finding the right mental health medication can sometimes be a slow process full of unpleasant side effects. Roughly 40% of people who take an antidepressant will stop taking the medication within the first three months because of side effects or because they believe the medication is ineffective. People who take antidepressants often complain of unpleasant side effects like nausea, sexual dysfunction, headaches, drowsiness, dry mouth, and increased anxiety. When a person experiences side effects, it is easy for them to become discouraged and assume that no medication will help their condition.

Side effects sometimes occur because people metabolize medications differently depending on their genetic code. For example, some people might metabolize an antidepressant more slowly, and a higher concentration of the medication in their body can cause unpleasant side effects. People who metabolize a medication very quickly might have fewer side effects but might need more of the medication to effectively treat depressive symptoms. Therefore, doctors are increasingly recommending genetic testing for depression medications to find the proper dosage and the right medication which may result in fewer side effects.

Take our 2-minute Depression quiz to see if you may benefit from further diagnosis and treatment.

Genetic testing is designed to be easy and painless. To complete the test, a laboratory collects a small sample of blood or saliva from the patient. The sample is usually sent to a pharmacogenomic testing laboratory to be analyzed. This lab sequences the DNA and analyzes any variations or changes in specific genes that are associated with how you respond to a particular medication. Testing for a specific kind of medication only has to be done once, but you may require additional pharmacogenomic testing if your doctor wants to evaluate you for another type of medication.

Because the field is still in its infancy, there is not pharmacogenomic testing available for every medication. But genetic testing is available for many of the medications that treat psychiatric conditions including anxiety, depression, bipolar disorder, schizophrenia, panic disorder, obsessive compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Here are just a few of the many psychiatric medications currently available for testing:

It is important to note that genetic testing is not always completely accurate. Because the field is still new, there are only a few studies supporting the claim that patients who undergo genetic testing for medication will have more positive outcomes than patients who do not. There also are limitations to what genetic testing can tell you about how your body will metabolize a medication. There is not one pharmacogenomic test that will provide information about all medications so you may need more than one test if you are taking more multiple meds. And, some medications cant be tested using this method (i.e. aspirin and other over-the-counter pain relievers).

Sometimes genes have a strong influence over how the medication works, and sometimes other factors are more influential. These factors can include gender, age, nutrition, smoking history, and pregnancy. Your other medical conditions and any medications you takeboth prescription and over-the-countercan also affect how medications are metabolized. Your doctor may take all of these factors into consideration when they prescribe you a medication and when they consider whether to recommend that you complete genetic testing.

Insurance coverage for genetic testing may vary depending on your insurance plan and personal history. You or your doctor may be required to submit documentation proving that you have a certain diagnosis or have experienced difficulty finding the right medication. It may be helpful to ask your healthcare provider for the specific procedure and medical billing codes for the lab tests theyd like to order before calling your insurance company about coverage. If your insurance doesnt cover the cost, check with the genetic testing company to see if they offer any payment assistancethese tests can cost a few hundred dollars.

Treating mental illness usually involves a combination of medication, psychotherapy, and psychoeducation. So its important to participate in other kinds of treatment and self-care activities while taking medication. Your diet, sleep, exercise, and other factors can also play a role in your mood and how your body responds to medication. As your body ages and develops, you may also find that medications will need to be adjusted by your doctor.

Talk to your doctor about whether genetic testing could be useful for helping you find the right medication. Patients who are in crisis or who have a history of difficulty in finding the right medication are sometimes more likely to be recommended for genetic testing. Your primary care doctor may also have to refer you to a psychiatrist to provide more specialized knowledge in selecting a medication or to evaluate whether genetic testing could be beneficial.

To prepare for your appointment, you may want to prepare notes about the following information:

Genetic testing isnt a magic solution to a persons mental health challenges, but it can sometimes provide your doctor with important information about how your body will metabolize certain medications. Many people, however, find the right medication for their symptoms without the use of genetic testing. So dont be discouraged if it is not an option or not covered by your insurance. It never hurts, however, to start a conversation with your doctor about your options. The testing may not inform him of the perfect medication, but it can alert a physician as to what medications are likely to cause adverse effects or be ineffective. So dont hesitate to talk to your healthcare provider about whether you might benefit from pharmacogenomic testing.

Last Updated: Jul 31, 2018

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Pharmacogenomics: What Is It and How Does DNA Testing for ...

Precision medicine and pharmacogenomics

Personalized medicine holds the promise that treatments will one day be tailored to your genetic makeup.

Modern medications save millions of lives a year. Yet any one medication might not work for you, even if it works for other people. Or it might cause severe side effects for you but not for someone else.

Your age, lifestyle and health all influence your response to medications. But so do your genes. Pharmacogenomics is the study of how a person's unique genetic makeup (genome) influences his or her response to medications.

Precision medicine aims to customize health care, with decisions and treatments tailored to each individual in every way possible. Pharmacogenomics is part of precision medicine.

Although genomic testing is still a relatively new development in drug treatment, this field is rapidly expanding. Currently, more than 200 drugs have label information regarding pharmacogenomic biomarkers some measurable or identifiable genetic information that can be used to individualize the use of a drug.

Each gene provides the blueprint for the production of a certain protein in the body. A particular protein may have an important role in drug treatment for one of several reasons, including the following:

When researchers compare the genomes of people taking the same drug, they may discover that a set of people who share a certain genetic variation also share a common treatment response, such as:

This kind of treatment information is currently used to improve the selection and dosage of drugs to treat a wide range of conditions, including cardiovascular disease, lung disease, HIV infection, cancer, arthritis, high cholesterol and depression.

In cancer treatments, there are two genomes that may influence prescribing decisions the genome of the person with cancer (the germline genome) and the genome of the cancerous (malignant) tumor (the somatic genome).

There are many causes of cancer, but most cancers are associated with damaged DNA that allows cells to grow unchecked. The "incorrect" genetic material of the unchecked growth the malignant tumor is really a separate genome that may provide clues for treatment.

One example is thiopurine methyltransferase (TPMT) testing for people who are candidates for thiopurine drug therapy. Thiopurine drugs are used to treat some autoimmune disorders, including Crohn's disease and rheumatoid arthritis, as well as some types of cancer, such as childhood leukemia.

The TPMT enzyme helps break down thiopurine drugs. People who are TPMT deficient don't break down and clear out these drugs quickly enough. As a result, the drug concentration in the body is too high and increases the risk of side effects, such as damage to the bone marrow (hematopoietic toxicity).

Genetic testing can identify people with TPMT deficiency so that their doctors can take steps to reduce the risk of serious side effects by prescribing lower than usual doses of thiopurine drugs or by using other drugs instead.

Although pharmacogenomics has great promise and has made important strides in recent years, it's still in its early stages. Clinical trials are needed not only to identify links between genes and treatment outcomes but also to confirm initial findings, clarify the meaning of these associations and translate them into prescribing guidelines.

Nonetheless, progress in this field points toward a time when pharmacogenomics will be part of routine medical care at least for some drugs.

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Precision medicine and pharmacogenomics - Mayo Clinic

- 183 records -

Original Research

Galvez JM, Restrepo CM, Contreras NC, Alvarado C, Caldern-Ospina CA, Pea N, Cifuentes RA, Duarte D, Laissue P, Fonseca DJ

Pharmacogenomics and Personalized Medicine 2018, 11:169-178

Published Date: 16 October 2018

Sychev DA, Levanov AN, Shelekhova TV, Bochkov PO, Denisenko NP, Ryzhikova KA, Mirzaev KB, Grishina EA, Gavrilov MA, Ramenskaya GV, Kozlov AV, Bogoslovsky T

Pharmacogenomics and Personalized Medicine 2018, 11:167-168

Published Date: 26 September 2018

Sychev DA, Levanov AN, Shelekhova TV, Bochkov PO, Denisenko NP, Ryzhikova KA, Mirzaev KB, Grishina EA, Gavrilov MA, Ramenskaya GV, Kozlov AV, Bogoslovsky T

Pharmacogenomics and Personalized Medicine 2018, 11:127-137

Published Date: 25 July 2018

Hernandez-Suarez DF, Botton MR, Scott SA, Tomey MI, Garcia MJ, Wiley J, Villablanca PA, Melin K, Lopez-Candales A, Renta JY, Duconge J

Pharmacogenomics and Personalized Medicine 2018, 11:95-106

Published Date: 8 June 2018

Kryukov AV, Sychev DA, Andreev DA, Ryzhikova KA, Grishina EA, Ryabova AV, Loskutnikov MA, Smirnov VV, Konova OD, Matsneva IA, Bochkov PO

Pharmacogenomics and Personalized Medicine 2018, 11:43-49

Published Date: 22 March 2018

Original Research

St Sauver JL, Olson JE, Roger VL, Nicholson WT, Black III JL, Takahashi PY, Caraballo PJ, Bell EJ, Jacobson DJ, Larson NB, Bielinski SJ

Pharmacogenomics and Personalized Medicine 2017, 10:217-227

Published Date: 24 July 2017

Zastrozhin MS, Brodyansky VM, Skryabin VY, Grishina EA, Ivashchenko DV, Ryzhikova KA, Savchenko LM, Kibitov AO, Bryun EA, Sychev DA

Pharmacogenomics and Personalized Medicine 2017, 10:209-215

Published Date: 7 July 2017

Chidambaran V, Zhang X, Martin LJ, Ding L, Weirauch MT, Geisler K, Stubbeman BL, Sadhasivam S, Ji H

Pharmacogenomics and Personalized Medicine 2017, 10:157-168

Published Date: 9 May 2017

Mirzaev KB, Zelenskaya EM, Barbarash OL, Ganyukov VI, Apartsin KA, Saraeva NO, Nikolaev KY, Ryzhikova KA, Lifshits GI, Sychev DA

Pharmacogenomics and Personalized Medicine 2017, 10:107-114

Published Date: 12 April 2017

Original Research

Sychev DA, Shuev GN, Suleymanov SS, Ryzhikova KA, Mirzaev KB, Grishina EA, Snalina NE, Sozaeva ZA, Grabuzdov AM, Matsneva IA

Pharmacogenomics and Personalized Medicine 2017, 10:93-99

Published Date: 31 March 2017

Review

Prince AER, Cadigan RJ, Henderson GE, Evans JP, Adams M, Coker-Schwimmer E, Penn DC, Van Riper M, Corbie-Smith G, Jonas DE

Pharmacogenomics and Personalized Medicine 2017, 10:49-60

Published Date: 20 February 2017

Original Research

Takahashi PY, Ryu E, Pathak J, Jenkins GD, Batzler A, Hathcock MA, Black JL, Olson JE, Cerhan JR, Bielinski SJ

Pharmacogenomics and Personalized Medicine 2017, 10:39-47

Published Date: 14 February 2017

Original Research

Frick A, Fedoriw Y, Richards K, Damania B, Parks B, Suzuki O, Benton CS, Chan E, Thomas RS, Wiltshire T

Pharmacogenomics and Personalized Medicine 2015, 8:81-98

Published Date: 26 February 2015

Original Research

Penney RB, Lundgreen A, Yao-Borengasser A, Edavana VK, Williams S, Dhakal I, Wolff RK, Kadlubar S, Slattery ML

Pharmacogenomics and Personalized Medicine 2014, 7:163-171

Published Date: 14 July 2014

Review

Sechler M, Cizmic AD, Avasarala S, Van Scoyk M, Brzezinski C, Kelley N, Bikkavilli RK, Winn RA

Pharmacogenomics and Personalized Medicine 2013, 6:25-36

Published Date: 4 April 2013

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Pharmacogenomics and Personalized Medicine - Dove Press