Implementation of Pharmacist-Led Pharmacogenomics

A study published in the Journal of the American Pharmacists Association (www.japha.org) presents some pretty clear evidence that the utility of pharmacogenomic testing is advancing. The momentum is growing from the regulatory/guideline end (FDA, CPIC, etc) and the real need seems to be in implementation – if pharmacogenomic testing is to be successful in clinical practice, pharmacists are going to need to take the lead. Obviously, we at RxGenomix agree. The study lays out a few key assertions and findings:

• Actionable pharmacogenomics (PGx) data are increasingly being incorporated into drug labeling and clinical practice guidelines.
• Having information about a patient’s genetics before and/or during use of a drug, and especially during use of multiple concomitant drugs, has obvious clinical implications, such as the ability to detect and thereby potentially mitigate drug-gene interactions.
• As medication experts on health care teams, pharmacists have many opportunities to be leaders in PGx.
• Implementing a pharmacist-led PGx service in a community-based practice setting that focuses on caring for vulnerable adults is feasible.
• Effective clinical decision support systems facilitate the use of PGx test results in clinical practice and, ultimately, the implementation of PGx services.
• Effective clinical decision support systems facilitate the use of PGx test results in clinical practice and, ultimately, the implementation of PGx services.

The study focuses on applying pharmacogenomics to patient care in the elderly population, where the pharmacist led the testing, interpreting and consulting to ensure that the drug gene interactions were evaluated and applied to medication therapy.

The primary objective of the study was to describe the processes involved in implementing this service and the process-related challenges and solutions associated with implementation. Secondary objectives were to describe pharmacists’ roles in implementation and to report the results of PGx consulting, including pharmacists’ recommendations and prescribers’ acceptance of these recommendations.

One of the most significant challenges to implementation, and one of the greatest opportunities for pharmacists to take the lead, was the knowledge and competency gaps in PGx. A pharmacist’s most essential role in successfully applying pharmacogenomic testing to patient care will be: interpreting and applying PGx data, determining how to disseminate the data to prescribers, advocating for appropriate PGx testing, and educating about the application of test results to clinical practice.

In this study, participants frequently used drugs posing drug gene interaction risks, with the majority (73.6%) reporting more than one interaction. The overwhelming majority (89.0%) of pharmacists’ recommendations to mitigate risks were accepted by referring prescribers.

The conclusion was that implementation of a pharmacogenomic testing service highlights the leadership role of pharmacists in moving PGx from research to practice.

A Little More About the Basics of Pharmacogenomics

It is well known that different individuals respond in different ways to the same drug. Moreover, it is increasingly being appreciated that genetics plays an important role in inter-individual variability in drug response.

Having information about an individual’s genetics before and during use of a drug, and especially during the use of multiple concomitant drugs, has obvious clinical implications. For example, having information about genetic variants in a patient’s cytochrome P450 (CYP450) system allows a clinician to identify a drug gene interaction (DGI) involving a drug and a gene coding for a CYP450 isoenzyme or other protein.

This information also lets a clinician identify a drug-drug-gene interaction (DDGI), which involves a complex interaction resulting from the ability to analyze and interpret PGx testing results and make clinical decisions based on those results may be a vital service for improving drug responses and patient outcomes. Indeed, services that incorporate PGx testing into patient care are emerging in primary care practices and community pharmacies.

To access the full article: JAPhA Article