Implementing pharmacogenetics with
CIPHER™
Personalized Medicine Program
Kristen K. Reynolds, PhD
VP Laboratory Operations
11-20-14
Property of PGxl Laboratories
CIPHER manages
the whole patient
Polypharmacy
Psychosis
ADHD
Chronic
Pain
Depression
Diabetes
Thrombosis
Hypertension
Stroke
Coronary Artery
Disease
Arrhythmia
Hyperlipidemia
Property of PGxl Laboratories
CIPHER interpretive support: Drug-Gene Pilot
•
Enhanced interpretive report format incorporating patient’s current med list
Drug-Drug Interactions
DRUG-DRUG INTERACTIONS:
ASPIRIN- PAROXETINE may result in an increased risk of bleeding.
ASPIRIN- CARVEDILOL or FUROSEMIDE may result in decreased diuretic and/or antihypertensive
efficacy.
ASPIRIN- LOSARTAN may result in decreased antihypertensive effects and an increased risk of renal
impairment.
CARVEDILOL- CLONIDINE result in increased risk of sinus bradycardia; exaggerated clonidine
withdrawal response (acute hypertension).
LEVOTHYROXINE- PAROXETINE may result in increased levothyroxine requirements.
Medications not metabolized or otherwise not accounted for in current genetic testing profile:
ASPIRIN
CARBIDOPA/LEVODOPA
CLONIDINE
CLOTRIMAZOLE
FUROSEMIDE
LEVOTHYROXINE
LYRICA
Property of PGxl Laboratories
SULFASALAZINE
Drug-Gene Pilot Stats (Feb-Sept 2014)
General Cohort Statistics
Physicians participating
(GP, psychiatry, cardiology, pain management, gerontology)
27
Patients included (Feb-Sept 2014)
703
Total medications
8090
Total drug-drug interactions found (excluding minor)
3113
Total meds with a genetic link
2955
psychotropics
28%
cardiovascular
32%
analgesics
20%
Other (allergy/asthma, cough, nausea, etc)
20%
Avg number meds/patient
Avg meds/patient with a genetic link
12
4
% of medications with conflict
44% of medications with a potential gene link had a variant
genotype identifying a Drug-Gene Conflict
87%
60
52%
50
40
30
20
20%
15%
13%
10
0
Minor
Moderate
Major
Contraindicated
PRODRUG OPIOIDS
43% of opioids had CYP2D6 contraindication
43%
SSRI ANTIDEPRESSANTS
87% of SSRIs had one or more gene conflicts
40%
single gene
conflict
47%
CYP and SLC6A4
conflict
87%
CARDIOVASCULAR MEDICATIONS
Clopidogrel
63%
Warfarin
35%
Beta-blockers
49%
Losartan
33%
Statins
Rosuvastatin 18%
0
10
Simvastatin 23%
20
30
Atorvastatin 43%
40
50
% of medications with gene conflict
60
70
80
Drug-Gene Pilot feedback surveys
Questions
(511 patients to date)
% of the
cases
General comments
Overall % of patients for whom
decisions changed based on report
52%
•
Used drug-drug interaction section
65%
Switched a medication
57.5%
Added or D/C medication without
switch
50%
Avoided an entire class
52.5%
•
Focused on an entire class
47.5%
•
Adjusted dose of current medication
50%
Made no regimen changes at all
45%
Saw improvements in outcomes and/or
patient satisfaction
67.5%
•
User friendly; easier to
understand; like the colored
symbols and alternative
meds to consider
Useful antidepressants,
antipsychotics,
anticoagulants, opioids
“Drug-drug interactions were
an eye-opening experience”
“Overall reduction in total Rx
meds was significant, 1525%”
Summary
•
Many factors influence drug safety and efficacy
•
CIPHER identifies significant risks across medication classes
•
Genotyping a patient for a single indication, drug, or gene is
unlikely to reveal the patient’s true risk burden based on their
co-morbidities and polypharmacy
•
Panel-based approach with drug-gene and drug-drug
interactions improves sensitivity
– ID high-risk drugs, safer doses and/or better alternatives
– different decisions 52% of the time resulting in improved outcomes and
satisfaction in 67% of cases
Personalized Medicine Program Outcome Goals
Decrease LOS
Do you have 1 or
of these goals?
Decrease
readmissions
Reduce Risk of
ADRs
Improve odds of
reaching
therapeutic goals
Reduce Cost of
ADRs
Reach
therapeutic goals
faster
Improve patient
adherence to
prescribers
instructions
Reduce
regulatory
and/or legal risk
Improve patient
satisfaction
Innovative,
Center of
Excellence
What is the cost of not having
Personalized Medicine Program?
What are initiatives are you
pursuing to reach these goals?
What would success look
like for each of these goals?
What would achieving 1 or
more of these goals mean?
Thank you!