Tagwerker Christian, Carias-Marines Mary Jane, Smith David J
Alcala Testing and Analysis Services, San Diego, CA, United States.
JMIRx Med. 2022 May 3;3(2):e32902. doi: 10.2196/32902.
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.
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.
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.
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.
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.
在过去十年中，用于确定适合个体患者治疗的正确药物和剂量的药物基因组学（PGx）方法的可用性有所增加。在临床环境中采用由此产生的PGx报告并监测临床结果是一项具有挑战性的长期任务。
本研究总结了一家疼痛管理诊所新采用的用于药物剂量和处方指导的扩展PGx深度测序面板。这项回顾性研究的主要结果报告了PGx数据似乎有助于优化药物处方和剂量的病例数量和所涵盖药物的类型。
描述了一个PGx面板，包括23个基因和141个单核苷酸多态性或插入缺失，结合PGx剂量指导以及药物-基因相互作用（DGI）和药物-药物相互作用（DDI）报告，以预防药物不良反应（ADR）。在两年期间，对一家疼痛管理诊所的患者（N = 171）进行了监测。对尿液毒理学、PGx报告和病程记录进行回顾性研究，以了解在向提供者提供PGx报告之前和之后处方方案的变化。一种额外的算法提供了DGI和DDI以预防ADR。
在提供了用药清单的患者PGx报告中（n = 146），57.5%（n = 84）显示一种或多种中度相互作用，5.5%（n = 8）显示至少一种严重的PGx相互作用。共有96名（65.8%）患者显示至少一种中度相互作用，15.1%（n = 22）显示一种或多种严重的DGI或DDI。基于所提供的102份PGx/DGI/DDI报告结果，观察到大量患者（85名，83.3%）的处方有积极变化，这些患者中特定药物在报告定义的药物类别内被停用或更换，或者添加了新药。
对于所有严重相互作用都采取了预防措施，并且在没有其他替代方案的情况下，仅容忍中度相互作用。本研究证明了扩展PGx面板与定制信息报告相结合在预防ADR和改善患者护理方面的应用。
