Using Pharmacogenomics and Precision Medicine to Improve Treatment Options

Even when following clinical guidelines, some patients will respond far better to treatment than others, and some will have worse side effects than expected. During a session at the Academy of Managed Care Pharmacy 2016 Nexus meeting, Nicole Scovis, PharmD, BCPS, BCACP, and Sandra Leal, PharmD, MPH, both of SinfoniaRx in Tucson, Arizona, explained how precision medicine can be integrated into primary care practice to improve care.

Most people tend to think mostly about genes when it comes to precision medicine, but the truth is that precision medicine also incorporates lifestyle and environment in how to prevent and treat disease. There are many factors that can impact a person’s response to treatment including diet, age, weight, and alcohol intake, Scovis explained.

While medications can be very effective, in some common conditions large proportions of patients are failing therapy, she added. Drug therapy is ineffective nearly half of the time in arthritis, more than 40% of the time in diabetes, and close to 40% of the time for asthma and depression.

Importantly, Scovis said, there is pharmacogenomic information out there about how drugs pair with genes in a number of areas: pain, hypertension, dyslipidemia, arrhythmia, depression, anxiety, schizophrenia, and more.

Leal took the time to explain how SinfoniaRx tested the implementation of pharmacogenomic interventions to reduce drug issues. Typically, the healthcare organization would pick good candidates out of the total population to be screened for pharmacogenomic issues, but SinfoniaRx took a different approach. They screened nearly everyone who came through the door as long as they fit 2 criteria: they had to have at least 2 medications that could be affected by pharmacogenomics and they had to have insurance that would cover the test.

Once a patient was screened, the report went to directly to the pharmacists and included information about what drugs may or may not have a genetic variant that would affect therapy. The pharmacist would review the medical chart to find out if the patient was stable on medication or could benefit from a change.

The success of the program was contingent on having stakeholders on board early on and to have someone who would ensure the process was being kept up. Initially, when the program started, physicians were ordering the tests, but that eventually began to disappear. In addition, after the test was ordered, often the report would sit on someone’s desk and no action would be taken.

“We really needed a leader in the process to make sure that the testing got done; to make sure that the results got interpreted correctly,” Scovis said.

It was crucial to be able to show that following the process would make a difference. The changes and results had to be documented and placed in the electronic health record so it could be consulted when ordering future medications and show the value.

“It’s really important to be able to show what is the return on investment,” Leal said. “If you’re paying for it, what is the benefit of it?”

The benefit of utilizing precision medicine in primary care in this way is that pharmacists and physicians will have access to the pharmacogenomic information and know if a drug should be dispensed or prescribed to a patient before there are issues.

“This is the future of how we will take care of people,” Scovis said.