Topic: Implementation of Neuropsychiatric Pharmacogenetics at Cincinnati Children’s Hospital Medical Center: 13 years of successful personalized medicine
Speaker: Laura B. Ramsey, PhD, Assistant Professor, Pharmacy Research, Division of Research in Patient Services, Co-director, Genetic Pharmacology Service, Cincinnati Children’s Hospital Medical Center
The Division of Child and Adolescent Psychiatry at Cincinnati Children’s Hospital Medical Center is the largest pediatric psychiatric unit in the country and a leader in using pharmacogenetically-guided dosing of psychotropic medications. Pharmacogenetic testing has been included in the initial intake of over 20,000 psychiatric patients since 2004 through the Genetic Pharmacology Service (GPS). Currently, variants in two genes (CYP2D6 and CYP2C19) are tested on the Psychiatric Expanded Panel using a custom TaqMan® Low Density Array. Long PCR is used for CYP2D6 full gene deletion and duplication. Genotypes are interpreted into metabolizer phenotypes in accordance with CPIC guidelines. After implementing single gene-drug testing in July 2004, feedback from psychiatrists led us to develop our first psychiatric panel (January 2005) and the expanded psychiatry panel (September 2013). Of the 6,147 expanded panel tests run between September 2013 and June 2016, 5,030 produced phenotypes for both genes. Reports included in the patient’s electronic medical record provide dosing recommendations (as percentage of normal dose) and drug-drug interaction alerts for 18 medications based on the metabolizer phenotypes. Clinicians use it to review dosing strategies for patients, particularly those with adverse effects or those that are treatment resistant. Another update is planned to include pharmacodynamic genotyping. An opioid panel is preemptively ordered for pectus excavatum surgery and as needed in other patients. Single gene-drug tests are also offered through the GPS. Clinical decision support alerts fire in three circumstances: to check for already available results, to order the relevant test, or to order a reinterpretation of a GPS test performed previously for a new medication. In summary, we have successfully implemented preemptive pharmacogenetic testing in a large inpatient psychiatric unit for the past 13 years, enabling physicians to adjust the dose of psychotropic medications based on CYP2D6 and CYP2C19 genotypes.
Presentation Slides: IGNITE CIWG webinar 2-1-2018