By Admera Health on Nov 5, 2020 4:09:03 AM
Pharmacogenomics (PGx) is the study of how genes affect a person’s response to drugs. The Admera Health PGxOne™ Plus test is a 60+ gene PGx test that provides insight into drugs for 16+ therapeutic areas, allowing for smarter medication management across multiple medical specialties. In tandem with RxVision™, Admera Health’s dynamic online reporting tool, the PGxOne™ Plus test delivers a complete PGx assessment for patient management solutions using high-integrity Gene and Gene-Drug interactions, which align with sources from the FDA, Clinical Pharmacogenetics Implementations Consortium (CPIC), Association for Molecular Pathologists (AMP), College of American Pathologists (CAP), and PharmGKB (learn more). In addition to gene-drug interactions, both the PGxOne™ Plus test and RxVision™ also provide users with insight into drug-drug, drug-food, drug-alcohol, and drug-lab interactions for the patient’s current medications. Admera’s goal is to offer healthcare providers easy to use tools to assist them with incorporating PGx testing into any practice. One such feature is the option within RxVision™ for the provider to check new medications against the patient’s available gene-drug interaction results, as well as drug-drug, drug-food, drug-alcohol, and drug-lab interactions that the new medication may cause. This includes interactions with the patient’s current medications.
To demonstrate how RxVision™ can be used to check new medications for relevant gene-drug interactions, consider John Smith, a 65-year-old patient who is recovering from a heart attack. He is on several heart-related medications and supplements to aid in his recovery. Due to the heart attack, John Smith has also been suffering from depression. He is currently taking the antidepressant, Lexapro™. However, after 3 months on Lexapro™, John has not experienced any therapeutic benefit from the medication and he would like to see if another medication would be better for him. To address John’s concerns and to gain more insight into his medications, his physician, Dr. Jane ordered a PGxOne™ Plus test. After 7-10 business days, John Smith’s PGxOne™ Plus test results were available on RxVision™.
To get started with RxVision™, Dr. Jane would log into her account and select her patient, John Smith. After selecting John’s report, Dr. Jane would be redirected to the page displayed on the left. The Current Medications and Medications of Interest option provides pharmacogenomics insight into the drugs that the patient is currently taking, including the gene-drug interactions for the medications Dr. Jane indicated she is interested in learning about. The Comprehensive Results option allows Dr. Jane to view how John’s genes interact with all the medications available in RxVision™ including the gene-drug interactions included in the Current Medications and Medications of Interest section. The Search By option allows Dr. Jane to search by Drug Name, Interaction, Therapeutic Area, and Gene-Drug Interaction. There are also menu options available to Modify Medications and to print the PGxOne™ Plus report.
In the Current Medications and Medications of Interest section, Dr. Jane would see Lexapro™ is listed as a “Use With Caution” gene-drug interaction. She would also see that Lexapro™ has several drug-to-drug interactions with some of John Smith’s other medications. Dr. Jane decides she would like to discontinue John’s use of Lexapro™ and prescribe a new antidepressant medication.
Before doing so, Dr. Jane checks to see if there is an antidepressant that might work well for John, based on his PGx results using the Search By option in RxVision™. Dr. Jane searches for alternative antidepressants and their related PGx information using the Therapeutic Area search option. She locates antidepressants within the Therapeutic Area labelled Psychiatry.
Upon reviewing the alternative antidepressants for John and considering all the factors that play a role in drug response, beyond gene-drug interactions, Dr. Jane decides prescribing Doxepin™ at a standard dosing regimen, may be a good alternative for her patient. She bases her decision on the combinatorial patient impact statement for Doxepin™ which states:
“Patients with this genotype are expected to have a normal response to standard dosing regimen. However, if doxepin will be used in this patient, please monitor for drug toxicities and adjust the dose accordingly. Physicians should follow FDA label recommendations and may incorporate CPIC guidelines.”
She is confident in Admera Health’s proprietary combinatorial patient impact (biological systems based) statement because RxVision™ also displays the individual Gene-Genotype-Patient Impact annotations for each gene by which Doxepin™ is impacted. As shown in the image above, the two genes that impact Doxepin™ are CYP2D6 and CYP2C19.
Being a thorough medication manager, Dr. Jane wants to explore the drug-drug, drug-alcohol, drug-food, and drug-lab interactions that might arise if she prescribes Doxepin™ for John in lieu of Lexapro™. To do so, Dr. Jane navigates to the Modify Medication option in RxVision™. In this area, Dr. Jane modifies John’s medication list by adding Doxepin™, choosing Doxepin™’s route of administration, dosage form, and dose. She also deletes Lexapro™. Dr. Jane checks Doxepin™’s Drug Interactions using the Check Drug Interactions button at the bottom of the screen.
Dr. Jane notices that a MODERATE interaction exists between Doxepin™ and alcohol and makes a note to counsel John on the danger of ingesting alcohol with Doxepin™ during her next patient consultation with him. Dr. Jane is satisfied with John’s new medication therapy management plan that she created using John’s PGxOne™ Plus test report in tandem with RxVision™, and is excited to discuss the new plan with John.
Dr. Jane chooses the PGxOne™ Plus test for all of her patients because she knows that most patients, as they age, will encounter additional conditions for which medications are prescribed. The PGxOne™ Plus test, with its comprehensive gene-drug coverage, will be more useful to her patients long term than a PGx test that only covers select therapeutic areas.
RxVision™ is a tool that a physician can use throughout the patient’s lifetime. Since the genetic testing is analyzing germline genes variants (the patient’s DNA will never change) and the test results will always be useful. There may be situations in the future where a patient will need to be on a new medication or undergo a medical procedure that will require the use of anesthetics or other types of medications. Having a PGxOne™ Plus report in conjunction with RxVision™ could potentially be lifesaving. RxVision™ also has a feature to let healthcare providers share a patient report with other providers allowing for the opportunity to optimize a patient’s care between institutions. Having an online reporting tool available as a patient gets on a new medication will assist healthcare providers to reduce potential adverse drug reactions and treatment failures for their patients.
In combination with the PGxOne™ Plus test, RxVision™ delivers a complete PGx assessment, with gene-drug interactions that align with sources from the FDA, guidelines from the Clinical Pharmacogenetics Implementations Consortium (CPIC), and the Association for Molecular Pathologists (AMP) – RxVision™’s comprehensive nature provides for a lifetime of utility. This online reporting tool allows providers to view Admera Health’s PGxOne™ Plus test results in an easy-to-use, dynamic format. This post serves as part-four in the RxVision™ blog series, that will touch upon the following topics:
RxVision™ is able to provide longer-term functionality for users with their PGx results—versus other static PGx reports
RxVision™ combines drug-drug, drug-food, drug-alcohol, and drug-lab interactions from a medication knowledge-base commonly used in EHRs, along with the patient's pharmacogenomics test results in one central data hub. Thus, eliminating the need to check for drug-drug, drug-food, and drug-lab interactions separately
This dynamic online reporting platform provides physicians the capability to print and share the report with other providers who see the same patient, as well as the ability to refer to other providers, that the patient or physician recommends
RxVision™ can be used in preemptive PGx workflows in addition to reactive PGx workflows