HelixTalk Episode #91 - 23 Reasons to be Excited about Personalized Medicine

Date posted: February 12, 2019, 6:00 am

In this episode, we are excited to have a special guest with us. Dr. Dyson Wake is Senior Clinical Specialist in Pharmacogenomics at NorthShore University HealthSystem’s Center for Molecular Medicine here in Chicagoland and is here to explain the current and future applications of pharmacogenomics to the area of personalized medicine, as well as expose some misconceptions.

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Key Concepts

1. Pharmacogenomics is not a new concept; however within the years since the completion of the Human Genome Project in 2003, there has been a greater emphasis on pharmacogenomics and its application to personalized medicine.
2. The Cytochrome P450 (CYP) system of Phase I metabolizing enzymes is affected by genetic variants, most notably CYP 2D6, 2C9, and 2C19. Other targets may include drug transporters (statins and antidepressants).
3. While organizations such as CPIC have released guidance for interpreting pharmacogenomic test results across many medication classes and disease states, these recommendations are not always acknowledged by other organizations in their own best practice documents.
4. Regardless of when an individual is tested and with which panel, it is important to interpret the results as part of a global picture of the patient’s health, factoring in other factors that influence a drug’s safety and efficacy. Remember, even if the pharmacogenomic results show a patient will respond to a given agent. You still must factor in patient adherence and also renal/hepatic function both of which will also influence drug exposure.

References

• Hicks JK, Sangkuhl K, Swen JJ, et al. Clinical Pharmacogenetics Implementation Consortium Guideline (CPIC) for CYP2D6 and CYP2C19 Genotypes and Dosing of Tricyclic Antidepressants: 2016 Update. Clin Pharmacol Ther. 2017 Jul;102(1):37-44.
• Cavallari LH, Lee CR, Beitelshees AL. Multisite Investigation of Outcomes With Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary Intervention. JACC Cardiovasc Interv. 2018 Jan 22;11(2):181-191.