Knowledge and opinions among Canadian academic physicians regarding genetic screening to prevent severe cutaneous adverse drug reactions

Chan, Felix L; Shear, Neil H.; Maharaj, Anuysha; Olteanu, Cristina; Hashimoto, Rena; Ziv, Michael; Dodiuk‐Gad, Roni P.

doi:10.1016/j.jaad.2019.04.040

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…To mention, a genetic assessment of HLA-A* 31:01 was not conducted. These results reinforce our previous study on “Knowledge and opinions among Canadian academic physicians regarding genetic screening to prevent severe cutaneous adverse drug reactions,” 22 indicating a major knowledge gap between the literature recommendations on genetic screening to prevent SJS/TEN and the use of these genetic tests among Canadian academic physicians. Numerous regulatory agencies have made recommendations for genetic screening prior to the administration of certain medications.…”

Section: Discussionsupporting

confidence: 88%

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Retrospective Study of Patients With SJS/TEN Treated at a Tertiary Burn Unit in Canada: Overview of 17 Years of Treatment

et al. 2021

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Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are adverse drug reactions. Objectives To learn about the clinical characteristics of patients with SJS/TEN including treatments provided, outcomes, and mortality. Methods We conducted a retrospective chart review of patients who were hospitalized with the diagnosis of SJS/TEN at the Ross Tilley Burn Center between the years 1999 and 2015. Results A total of 43 patients were identified with a mean age of 54 ± 19 (58, 18-85). The most common offending medications were allopurinol and carbamazepine. The overall mortality rate in our study is 21% with the most common causes of death being multiorgan failure and sepsis. The majority of our patients had oral (84%), ocular (79%), and genital (60%) involvement during hospitalization. Our data revealed that combination treatment involving oral corticosteroids with intravenous immunoglobulin (IVIG) had the highest mortality rate in our study since 55% (6/11) of patients who were treated in this manner passed away compared to 11% (2/18) of patients passing away who were treated with solely IVIG and 33% (1/3) who were treated with only supportive care. Our study also demonstrates the addition of etanercept and cyclosporine treatment in the second time period we studied: 2008-2015 versus the earlier time period of 1999-2007. None of the patients in our study who were treated with therapies including cyclosporine and/or etanercept passed away. Conclusions Our study sheds light on a possible beneficial role of cyclosporine and etanercept for the treatment of SJS and TEN and reinforces the necessity of a multidisciplinary care team for patients.

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Section: Discussionsupporting

confidence: 88%

“…Costs vary around $150-300 USD/test. 22 Overall, making these genetic tests mandatory prior to prescribing certain medications, such as allopurinol, requires financial and moral support from public health.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Study of Patients With SJS/TEN Treated at a Tertiary Burn Unit in Canada: Overview of 17 Years of Treatment

et al. 2021

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“…Two of these studies highlighted the lack of physician awareness, despite guideline recommendations, for human leukocyte antigen genotyping prior to carbamazepine and allopurinol treatment—which in some haplotypes can result in fatal dermatological complications. 29 , 30 Another study focused on psychotropic medications and found the majority of Canadian physicians who previously ordered at least one PGx test, to understand the PGx report. 31 However, this understanding and satisfaction declined from clinician scientists, to psychiatrists, to general practitioners.…”

Section: Discussionmentioning

confidence: 99%

Pharmacogenomic‐based personalized medicine: Multistakeholder perspectives on implementational drivers and barriers in the Canadian healthcare system

Subasri

Barrett

Sibalija

et al. 2021

Clinical Translational Sci

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Pharmacogenomics (PGx) based personalized medicine (PM) is increasingly utilized to guide treatment decisions for many drug-disease combinations. Notably, London Health Sciences Centre (LHSC) has pioneered a PGx program that has become a staple for London-based specialists. While implementational studies have been conducted in other jurisdictions, the Canadian healthcare system is understudied. Herein, the multi-stakeholder perspectives on implementational drivers and barriers are elucidated. Using a mixed-method qualitative model, key stakeholders and patients from LHSC's PGx-based PM clinic were interviewed and surveyed respectively. Interview transcripts were thematically analyzed in a stepwise process of customer profiling, value mapping and business model canvasing. Value for LHSC located specialist users of PGx was driven by the quick turnaround time, independence of the PGx clinic, and the quality of information. Engagement of external specialists was only limited by access and awareness, while other healthcare non-users were limited by education and applicability. The major determinant of successful adoption at novel sites were institutional champions. Patients valued and approved of the service, expressed a general willingness to pay, but often traveled far to receive genotyping. This paper discusses the critical pillars of education, awareness, advocacy, and efficiency required to address implementation barriers to healthcare service innovation in Canada. Further adoption of PGx practices into Canadian hospitals is an important factor for advancing system-level changes in care delivery, patient experiences and outcomes. The findings in this paper can help inform efforts to advance clinical PGx practices, but also the potential adoption and implementation of other innovative healthcare service solutions.

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Severe cutaneous adverse reaction associated with antiseizure medications: Diagnosis, management, and prevention

Brandt

McGuire²,

Uetrecht

2021

Epilepsy & Behavior

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Knowledge and opinions among Canadian academic physicians regarding genetic screening to prevent severe cutaneous adverse drug reactions

Cited by 3 publications

References 5 publications

Retrospective Study of Patients With SJS/TEN Treated at a Tertiary Burn Unit in Canada: Overview of 17 Years of Treatment

Retrospective Study of Patients With SJS/TEN Treated at a Tertiary Burn Unit in Canada: Overview of 17 Years of Treatment

Pharmacogenomic‐based personalized medicine: Multistakeholder perspectives on implementational drivers and barriers in the Canadian healthcare system

Severe cutaneous adverse reaction associated with antiseizure medications: Diagnosis, management, and prevention

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