Clinical studies

Four Nursing Homes in Ontario. Measurements Potential drug therapy problems (DTPs) for study cohort were identified during a medication review by a pharmacist using pharmacogenetic (PGx) clinical decision support to identify medication change opportunities. The number of DTPs identified during a standard medication review was compared with the number of DTPs identified with a PGx clinical decision support. Analysis of medication dispensing data at enrollment compared with dispensing in a 60-day window following medication review were compared for the PGx-tested study cohort with controls. Results Prescription patterns of 90 study participants were compared with 895 controls for the same time period. Study participants were on 7 to 47 drugs, of which drugs with PGx indications ranged from 1 to 17 medications. The average medication load was 4.6 medications with PGx indications per person, whereas the controls were on 3.5 PGx drugs. Furthermore, 94% of cases and 84% of controls were on 2 or more drugs with PGx indication during the study period. Pharmacogenetic analysis identified 114 distinct DTPs in the 90 study participants, of which 29 were classified as serious. In this study, over 35% of residents were treated with antidepressants; of these, 64% have altered CYP2C19 or CYP2D6 metabolism and could benefit from drug dose adjustment or from a switch to alternative antidepressants. Twenty percent of residents were treated with hydromorphone, of which 30% have reduced response to opioids because of variations in the OPRM1 gene. Conclusions and Implications This study demonstrated the clinical potential of PGx-based medication optimization for NH residents, impacting the management of depression, chronic pain, heart disease, and gastrointestinal symptoms. DOI:https://doi.org/10.1016/j.jamda.2020.04.009

Despite the many hurdles, PGx testing has great promise to optimize medication selection and dosing in psychiatry practice. While the clinical evidence‐base is growing, a collaborative multi‐stakeholderapproach can overcome hurdles discussed in this review. The development of user‐friendly systems for test ordering, guidelines for use and communication of results, reimbursement policies, and strategies for effectively educating health‐care providers and the public will facilitate the successful implementation of PGx testing into the psychiatric clinic. DOI: 10.1002/pcn5.26

Question  What is the time course for benefit and risk with dual antiplatelet therapy for individuals with minor ischemic stroke or transient ischemic attack (TIA) who carry CYP2C19 loss-of-function (LOF) alleles? Findings  In this secondary analysis of the Ticagrelor or Clopidogrel With Aspirin in High-risk Patients With Acute Nondisabling Cerebrovascular Events II (CHANCE-2) randomized clinical trial, the benefit with ticagrelor and aspirin was predominately present in the first week and persisted throughout the 21-day period of dual antiplatelet therapy with ticagrelor and aspirin in patients with a minor stroke or TIA who carried CYP2C19 LOF alleles. Meaning  The findings suggest that the benefit with ticagrelor and aspirin found in CHANCE-2 among patients with a minor ischemic stroke or TIA carrying CYP2C19 LOF alleles was predominant in the first week, with a small benefit observed in the following 2 weeks. https://jamanetwork.com/journals/jamaneurology/article-abstract/2793534?guestAccessKey=8aed09e4-5890-44fc-91a7-6b739179443a&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamaneurology&utm_content=etoc&utm_term=080822#:~:text=JAMA%20Neurol.%202022%3B79(8)%3A739%2D745.%20doi%3A10.1001/jamaneurol.2022.1457