Biotechnology Healthcare - November/December 2008 - (Page 5) PERSONALIZED MEDICINE Role of Genetic Data Emerges in Antismoking Effort Bob Carlson, MHA, Senior Contributing Editor S moking may be the leading cause of preventable death in the United States, but there aren’t many new smoking cessation products available. Smokers who want to quit can choose from nicotine replacement therapies that have been around for decades — patches, gums, lozenges, nasal sprays, and inhalers — and two non-nicotine prescription drugs, bupropion (Wellbutrin or Zyban) or varenicline (Chantix). With 45 million U.S. smokers and hundreds of millions more in foreign markets, nicotine dependence looks like a good market for new treatments, but more efficient methods than trial-and-error will be needed to learn which drug is going to work best for an individual smoker who wants to quit. Researchers are already finding answers to that question. ducing withdrawal and craving, and increases dopamine levels, albeit less than smoking itself does. So far, researchers have identified several genetic markers that predict response to treatment for smoking cessation. “The field of pharmacogenetics and nicotine dependence treatment is still in its infancy,” says Lerman. “Before [its] findings can be translated into clinical practice, we need independent validation trials, and these validation studies are just starting to come out.” The pharmacogenetics of smoking cessation treatments will grow out of infancy as more smoking cessation drugs come to market. But these drugs will be pricey, and genotyping tests will add even more cost. That brings up the question of whether it will make sense for employers to pay for the tests and the drugs. VERY HOT TOPIC WHERE THE MONEY IS The field of pharmacoAccording to a study published in Biolog- genetics “is very comFor years, employers have been shifting ical Psychiatry, smokers with the CYP2B6*6 plex and involves interhealthcare costs to workers. But that trend may genotype appear to be good candidates for actions of many different have peaked — at least, for larger companies. genes,” says Penn’s bupropion treatment for smoking cessation Caryn Lerman, PhD. “We work with large, self-insured compa(Lee 2007). The CY2B6 gene codes for the nies with employee bases of 2,000 and up, and primary enzyme that metabolizes bupropion. our clients feel that they’ve done about as much shifting of Smokers with one or two copies of the CYP2B6*6 costs to employees as they can do,” says Michael Cryer, variant had a harder time quitting, but were 3 times more MD, senior consultant and a medical director with Hewitt likely to quit and stay off cigarettes at six months when Associates, the human resources consulting company. “At treated with bupropion than smokers in the placebo group. this point, they feel that the biggest potential financial return Conversely, smokers with the CYP2B6*1 variant did not is in keeping people healthy and on the job, because then you benefit from bupropion treatment in quitting. About 30 can reduce total costs over the time they’re with you.” percent of smokers in this group quit regardless of whether A recent survey seems to corroborate Cryer’s experience. they were given bupropion or a placebo. Released in June, the survey of member companies of the “Pharmacogenetics and nicotine dependence treatment National Association of Manufacturers and the ERISA Inis a very hot topic because there is tremendous variabildustry Committee found that 71 percent use incentives to ity in response to different treatments for smoking cessadrive employee participation in health management protion,” says Caryn Lerman, PhD, deputy director of the grams — compared to 62 percent last year (see next page). Abramson Cancer Center at the University of PennsylvaA positive return on investment is certainly needed when nia, and a coauthor of this study. “If we can appropriately you start $3,800 in the hole. That’s about how much more personalize therapy based on genotype, then we will have a smoker costs a company than a nonsmoker, according to increased efficacy of our treatment.” the Centers for Disease Control and Prevention. The addiBupropion increases the levels of dopamine and nortional cost is attributed to lost productivity due to sick epinephrine, brain chemicals involved in the pleasurable days and absences, and costs associated with a higher effects of smoking, and also may block nicotinic recepprevalence of hypertension and respiratory conditions. tors in the brain. Varenicline, which was approved in An effective smoking cessation program can eliminate 2006, also blocks certain nicotinic receptors, thereby rethat extra cost in two to three years, Cryer claims. He estiNOVEMBER/DECEMBER 2008 · BIOTECHNOLOGY HEALTHCARE 5
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