Providers’ Perspectives on the Clinical Utility of Pharmacogenomic Testing in Pediatric Patients

Liko, Ina; Lee, Yee Ming; Stutzman, Danielle; Blackmer, Allison B.; Deininger, Kimberly M.; Reynolds, Ann; Aquilante, Christina L.

doi:10.2217/pgs-2020-0112

Cited by 13 publications

(16 citation statements)

References 46 publications

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“…Medical liaisons from pharmacogenetic testing vendors could provide another support resource, although their expertise may not translate to medical realm. Overall, this highlights the need of providing more pharmacogenetic training and other resources for healthcare providers, which is consistent with the findings of Liko et al [49].…”

Section: Discussionsupporting

confidence: 91%

“…Many clinicians believe commercial pharmacogenetic testing has moderate clinical utility, despite its limitations and conflicting evidence in the literature [49]. However, these findings may be skewed in favor of pharmacogenetic testing since several of these studies were performed at sites where clinicians were already familiar with pharmacogenetics [50][51][52][53].…”

Section: Discussionmentioning

confidence: 99%

“…A recent survey of clinicians also indicated that 85% of respondents were concerned about the lack of clear guidance for clinical application [54]. This trend is troubling considering that many clinicians who use this type of test to guide clinical decision-making may not have an extensive pharmacogenetic knowledge to be sufficiently proficient in interpreting the test reports, among other perceived barriers [20,49,55]. Considering these factors, a multidisciplinary approach should be considered when interpreting pharmacogenetic test results.…”

Section: Discussionmentioning

confidence: 99%

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The Utility of Pharmacogenetic-Guided Psychotropic Medication Selection for Pediatric Patients: A Retrospective Study

et al. 2021

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Background: To describe trends and clinical experiences in applying commercial pharmacogenetic testing among pediatric patients with neuropsychiatric disorders. Methods: Demographic and clinical data of patients receiving GeneSight® testing from January 2015 to November 2016 at an urban pediatric hospital were retrospectively extracted from medical charts. Outcome data included pharmacogenetic test results and medication prescriptions before and after the test. Results: A total of 450 patients (12.1 ± 4.3 years) diagnosed with anxiety disorder, attention deficit hyperactivity disorder, developmental disorders including autism, and/or a mood disorder received testing, and 435 of them were prescribed medications. Comparing data before and after testing, the total number of psychotropic prescriptions were reduced by 27.2% and the number of prescribed medications with severe gene-drug interactions decreased from 165 to 95 (11.4% to 8.9% of total medications prescribed). Approximately 40% of actionable genetic annotation were related to CYP2CD6 and CYP2C19. Patients of Asian descent had significantly higher likelihood than other races of being classified as poor to intermediate metabolizers of antidepressants, mood stabilizers, and antipsychotics (p = 0.008, 0.007, and 0.001, respectively). Diagnoses, including autism spectrum disorder, were not associated with increased risks of severe gene-drug interactions. Conclusions: Pharmacogenetic testing in child and adolescent psychiatry is currently based on few clinically actionable genes validated by CPIC and/or FDA. Although this approach can be moderately utilized to guide psychotropic medication prescribing for pediatric patients with psychiatric disorders, clinicians should cautiously interpret test results while still relying on clinical experience and judgment to direct the final selection of medication.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Utility of Pharmacogenetic-Guided Psychotropic Medication Selection for Pediatric Patients: A Retrospective Study

et al. 2021

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“…Despite the increase in the number of package inserts with PGx information 1 and guidelines from CPIC and DPWG, many providers are likely unaware of this information specifically and/or have limited understanding of PGx testing in general. 40,[45][46][47][48] Providers who are not aware or knowledgeable about PGx testing or have doubts about the clinical benefits of testing may have be reluctant to authorize testing or change prescriptions, which may have accounted for the muted response experienced by the pharmacists in this study. In other studies (though not in community pharmacy settings), the addition of PGx test results improved or resulted in high physician acceptance of pharmacist recommendations.…”

Section: Discussionmentioning

confidence: 99%

Independent Community Pharmacists’ Experience in Offering Pharmacogenetic Testing

Haga¹,

Mills²,

Moaddeb³

et al. 2021

PGPM

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This study assessed pharmacist experiences with delivering pharmacogenetic (PGx) testing in independent community pharmacies. Methods: We conducted a cluster randomized trial of independent community pharmacies in North Carolina randomized to provide either PGx testing as a standalone service or integrated into medication therapy management (MTM) services. Surveys and pharmacist data about the delivery of PGx testing were collected. Semi-structured interviews were also conducted. Results: A total of 36 pharmacists participated in the study from 22 pharmacies. Sixteen pharmacists completed the pre-study and post-study surveys, and four pharmacists completed the semi-structured interviews. Thirty-one percent (11/36) of pharmacists had had some education in personalized medicine or PGx prior to the study. The only outcome that differed by study arm was the use of educational resources, with significantly higher utilization in the PGx testing only arm (p=0.007). Overall, compared to the pre-study assessment, pharmacists' knowledge about PGx significantly improved post-study (p=0.018). In the post-study survey, almost all pharmacists indicated that they felt qualified/able to provide PGx testing at their pharmacy. While 75% of pharmacists indicated that they may continue to provide PGx testing at their pharmacy after the study, the major concerns were lack of reimbursement for PGx counseling and consultation given the necessary time required. Conclusion:Our findings demonstrated a positive experience with delivering PGx testing in the community pharmacy setting with little difference in pharmacists' experiences in providing PGx testing with or without MTM. Pharmacists were confident in their ability to provide PGx testing and were interested in continuing to offer testing, though sustained delivery may be challenged by lack of prescribing provider engagement and reimbursement.

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“…When it contains properly integrated PGx data, an EHR should be able to support timely access to genomic information at the point of care, trigger clinical decision support mechanisms, and facilitate ordering tests and tracking their results as well as notifying patients and families [ 48 ]. A recent survey of multidisciplinary healthcare providers found that 71.3% were slightly or not at all familiar with PGx, which suggests additional education and electronic resources are needed for pediatric PGx examples [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Implementing Pharmacogenomics Testing: Single Center Experience at Arkansas Children’s Hospital

Gill

Porter-Gill

et al. 2021

JPM

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Pharmacogenomics (PGx) is a growing field within precision medicine. Testing can help predict adverse events and sub-therapeutic response risks of certain medications. To date, the US FDA lists over 280 drugs which provide biomarker-based dosing guidance for adults and children. At Arkansas Children’s Hospital (ACH), a clinical PGx laboratory-based test was developed and implemented to provide guidance on 66 pediatric medications for genotype-guided dosing. This PGx test consists of 174 single nucleotide polymorphisms (SNPs) targeting 23 clinically actionable PGx genes or gene variants. Individual genotypes are processed to provide per-gene discrete results in star-allele and phenotype format. These results are then integrated into EPIC- EHR. Genomic indicators built into EPIC-EHR provide the source for clinical decision support (CDS) for clinicians, providing genotype-guided dosing.

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Providers’ Perspectives on the Clinical Utility of Pharmacogenomic Testing in Pediatric Patients

Cited by 13 publications

References 46 publications

The Utility of Pharmacogenetic-Guided Psychotropic Medication Selection for Pediatric Patients: A Retrospective Study

The Utility of Pharmacogenetic-Guided Psychotropic Medication Selection for Pediatric Patients: A Retrospective Study

Independent Community Pharmacists’ Experience in Offering Pharmacogenetic Testing

Implementing Pharmacogenomics Testing: Single Center Experience at Arkansas Children’s Hospital

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