Children's Hospitals Today - Spring 2017 - 21
GENETICS / FEATURE
common it is for all our patients to have genetic testing
available in their electronic health record before they're
prescribed a high-risk pharmacogenetic drug. The idea is to
focus on genes and drugs with clear evidence genetic testing
should be used to improve prescribing."
Still, it's not all about the genes. "We have to consider
age, renal function, liver function and drug interactions,"
Relling says. "There are a lot of things that account for why
medications work well for some patients and not others, and
genetics is just one of those things." So Relling and her team
try not to oversell or undersell pharmacogenetics. "It's not
going to eliminate all adverse drug effects-and it's not going
to make every drug work perfectly for every patient," she says.
But, she adds, it's important to use this information for
certain patients, especially as approaches to conducting
genetic testing takes a stronger hold in health care.
"As more people have their genomes tested for important
genomic variations, the question for clinicians is not whether
to order a genetic test-the question is what genetic variations
are so important that I should use them in prescribing
medications or making decisions in clinic," Relling says.
how this works, Vinks and his team at Cincinnati Children's
identified voriconazole (an anti-fungal used in critically ill
patients after transplants) was the right drug for a patient
based on genetics and reduced the number of days to the
effective dose from 29 to 6.5.
The costs
Currently, the cost of pharmacogenomic testing varies.
Generally, a test can run about $1,000. But Manzi says her
team runs a 225-gene panel for hundreds of dollars. However,
certain tests can run into the thousands. The question is who
shoulders the cost? Will insurance cover it? In some cases,
yes. At Cincinnati Children's, for example, the team uses
pharmacogenomic testing as a standard of care in psychiatry,
and when the hospital bills insurance, the organization has a
good track record of getting it covered, Ramsey says.
In other cases, insurance does not cover the cost of testing.
While Manzi has succeeded in convincing some insurance
companies to authorize the testing, there are instances
where they said, "No," and she has sent 20-pound binders
Next-level information
At Cincinnati Children's, the Genetic Pharmacology
Service dates back to 2004. That's when
providers started genotyping every patient
GENETIC TESTING
admitted to the psychiatry unit, and
The sequencing of human
each genotype result came back with
DNA in order to discover
genetic differences, anomalies
a recommendation on the best drug
or mutations
selection and dosing. Since then,
about 22,000 patients have been
through the testing process.
Today, the team is taking
the program to the next
PHARMACOGENETICS
level by making the data
How
variation in
more accessible to inform
one single gene
drug choice and dosing
influences the
decisions
for
patients.
response to a
"This means getting all this
single drug
information
even
more
accurately reported into
the electronic health record;
then make links where
providers
can-with
one
click-see immediately what
the result and the actionable
recommendation
are,"
says
PHARMACOGENOMICS
Alexander (Sander) A. Vinks,
A broader term, which
Pharm.D., Ph.D., FCP, co-director
studies how all of the genes
of Cincinnati Children's Genetic
(the genome) can influence
Pharmacology Service. In one example of
responses to drugs
GENOTYPE
An individual's
collection of
genetic variants
LEARN THE LINGO
GENE
A unit of heredity
that is transferred
from a parent
to offspring and
determines some
characteristic of
the offspring
GENOME
The complete set of genes
present in a cell or organism
CHILDREN'S HOSPITAL S TODAY Spring 2017
21
Table of Contents for the Digital Edition of Children's Hospitals Today - Spring 2017
Contents
Children's Hospitals Today - Spring 2017 - Cover1
Children's Hospitals Today - Spring 2017 - Cover2
Children's Hospitals Today - Spring 2017 - Contents
Children's Hospitals Today - Spring 2017 - 2
Children's Hospitals Today - Spring 2017 - 3
Children's Hospitals Today - Spring 2017 - 4
Children's Hospitals Today - Spring 2017 - 5
Children's Hospitals Today - Spring 2017 - 6
Children's Hospitals Today - Spring 2017 - 7
Children's Hospitals Today - Spring 2017 - 8
Children's Hospitals Today - Spring 2017 - 9
Children's Hospitals Today - Spring 2017 - 10
Children's Hospitals Today - Spring 2017 - 11
Children's Hospitals Today - Spring 2017 - 12
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Children's Hospitals Today - Spring 2017 - 14
Children's Hospitals Today - Spring 2017 - 15
Children's Hospitals Today - Spring 2017 - 16
Children's Hospitals Today - Spring 2017 - 17
Children's Hospitals Today - Spring 2017 - 18
Children's Hospitals Today - Spring 2017 - 19
Children's Hospitals Today - Spring 2017 - 20
Children's Hospitals Today - Spring 2017 - 21
Children's Hospitals Today - Spring 2017 - 22
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Children's Hospitals Today - Spring 2017 - 24
Children's Hospitals Today - Spring 2017 - 25
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Children's Hospitals Today - Spring 2017 - Cover3
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