Q&A with Dr. Josiah Allen: The role of genetic screening for medications

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If you have spent months and months trying to determine if a medication is working for you, you are not alone…and now, the doctors at  St. Elizabeth Healthcare are offering a new method to determine which medications will work best for you.

St. Elizabeth’s Pharmacogenomic Screening program, a cornerstone of precision medicine, offers a profound glimpse into the future of tailored treatment plans.

By examining an individual’s genetic makeup and medication response, St. Elizabeth pioneers a new era of personalized healthcare. This comprehensive program not only reduces the risk of adverse drug reactions but also streamlines the path to effective and efficient therapeutic solutions, marking a pivotal advancement in patient outcomes.

Dr. Josiah Allen, Pharmacogenomics Pharmacist for St. Elizabeth, shared more about how screening patients can help doctors select better medications for their condition.

LINK nky: What are the key benefits of pharmacology screening, and how does it contribute to personalized medicine in healthcare?

Dr. Allen: “Pharmacology screening, also known as pharmacogenomics, looks at how you respond to medication, changes in your DNA that can be passed down from parent to child, and how you metabolize your medication. How you break it down may affect how you respond to medication. Some people take a tiny dose and have all the side effects while others may require larger doses for an effect. Pharmacology screening helps us determine what will likely work for that individual.”

LINK nky: Could you explain in more detail how pharmacology testing works and how it helps healthcare providers make more informed treatment decisions?

Dr. Allen: “The test itself is either a cheek swab or a blood test, usually a cheek swab. By taking cheek cells, we can learn how your liver processes medication. We then send it to the lab, the lab does the analysis and looks at changes to different genes that may influence medication response.

“When we think about medications that are helpful, oftentimes we’re trying to get the right dose, kind of that ‘Goldilocks’ level. Think about the body as a sink half-filled with water. How high the faucet is turned on and how big the drain is will determine how fast the sink fills up. Someone who is a slow metabolizer is like turning the faucet on full blast…you’ll have side effects as a result. Or, you could be a fast metabolizer, like a large drain, with the medication not sticking around long enough to make an effect. With genetic testing, we’re able to determine the size of the drain. This helps us know if we need to adjust your dose, which is like turning the faucet up or down.” 

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The pharmacogenomics testing process consists of three simple steps including DNA collection, laboratory analysis and results. Learn more about how your specific genes interact with your prescribed medications through pharmacogenomic testing.

LINK nky: The website mentions the potential for reducing adverse drug reactions. Could you share some specific examples or success stories where screening has made a significant impact on patient outcomes?

Dr. Allen: “We have two examples where we use this kind of screening – cancer care and antidepressants or psychiatric medications. With cancer medications, the goal is to kill the cancer and not harm the patient in the process. Because we’re using medications that are toxic to cancer, it can also be toxic to the person. We want to lower the impact on the patient. If you’re a slow metabolizer, those medications can build up and cause harm. Only a handful of hospitals have this standard of practice of screening before these medications are given. If the screening process is done, we can catch these medication problems ahead of time.

The other example is with antidepressants or psychiatric medication. A lot of patients have to try two, three, or four different medications before they find something that will work for them. Being on medications for 8-12 weeks and then changing because it isn’t working means we have a patient who is spending a long time feeling poorly. If we can help identify medications that will be more effective for people, we can get them feeling better, faster.”

For example, we worked with a woman who suffered from anxiety and depression. She had tried several different medications in the past and all of them either didn’t work or caused side effects. She turned to alcohol and lost her job due to her drinking. Her provider ordered the genetic testing. Her test results explained why she had side effects to certain medications and why other medications didn’t work for her. It also helped us identify a medication that would be more likely to be processed normally in her body. By finding a medication that actually worked to treat her anxiety and depression and along with other things like therapy and additional support, she’s been sober for over a year, has gotten a new job, and has gotten back on track.

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In another example, a man with colorectal cancer was prescribed a chemotherapy drug. Part of our standard practice for anyone who gets this drug is to order genetic testing. He was found to have a genetic variant that would really increase his risk of potentially severe side effects from the medication. Once we knew his results, we were able to reduce his dose to a level that would be safe while still treating his cancer. So far he hasn’t had any side effects and his cancer hasn’t progressed – exactly what we’d hope for!

LINK nky: What types of patients are the best candidates for this type of screening?

Dr. Allen: “Our focus is on particular drug types. Antidepressants are a big part of our testing. We test cancer patients for particular chemotherapy agents and patients getting cardiovascular medication. With antidepressants, if a patient has failed one or more of their medications, it’s actually very cost-effective to do the testing and see where we can go next in order to not only find the right medication but also save the patient money in the long run.”

LINK nky: Can you elaborate on the patient experience when undergoing screening? What can individuals expect in terms of the process and the benefits they may receive?

Dr. Allen: “At St. Elizabeth, our pharmacy team plays a pivotal role. When this takes place in primary care, the provider orders the test, and the results are sent to our pharmacogenetics-trained team. They review the patient’s history and recommend the next medication to try. This recommendation is then discussed with the provider, who educates the patient. We’re also in the process of implementing a consultation process to further assist patients.”

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LINK nky: How much does it cost the patient?

Dr. Allen: There’s a common misconception about the expense, but our process here at St. Elizabeth Healthcare is quite affordable. The maximum cost is $350, and there are options for financial assistance. A recent study showed an average savings of $1,900 per patient over a year compared to those who did not receive the screening. This underscores the significant cost-effectiveness of the testing.”

LINK nky: How is St. Elizabeth Healthcare staying at the forefront of pharmacological advancements, and are there any plans to expand or enhance these services in the future?

Dr. Allen: “We are currently one of a handful of hospitals doing this testing at this frequency. Other hospitals only test a handful of patients. We screen well over 100 patients per month and we have a number of plans to expand our screening processes. St. Elizabeth will be upgrading our electronic health records so that information flows more easily into our system for providers across the system, like cardiologists and psychiatrists.

St. Elizabeth is also planning on providing more education on this relatively new technology. We have a lot of work we have to do to get people up to speed on this as it isn’t something that has been traditionally taught in medical school.”

To learn more about genetic screening for medications through St. Elizabeth, please call 859-301-GENE (4363), email [email protected] or visit the website by clicking here.

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