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Potential utility of precision medicine for older adults with polypharmacy: a case series study

Overview of attention for article published in Pharmacogenomics and Personalized Medicine, April 2016
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Title
Potential utility of precision medicine for older adults with polypharmacy: a case series study
Published in
Pharmacogenomics and Personalized Medicine, April 2016
DOI 10.2147/pgpm.s101474
Pubmed ID
Authors

Joseph Finkelstein, Carol Friedman, George Hripcsak, Manuel Cabrera, Finkelstein, Joseph, Friedman, Carol, Hripcsak, George, Cabrera, Manuel

Abstract

Pharmacogenomic (PGx) testing has been increasingly used to optimize drug regimens; however, its potential in older adults with polypharmacy has not been systematically studied. In this hypothesis-generating study, we employed a case series design to explore potential utility of PGx testing in older adults with polypharmacy and to highlight barriers in implementing this methodology in routine clinical practice. Three patients with concurrent chronic heart and lung disease aged 74, 78, and 83 years and whose medication regimen comprised 26, 17, and 18 drugs, correspondingly, served as cases for this study. PGx testing identified major genetic polymorphisms in the first two cases. The first case was identified as "CYP3A4/CYP3A5 poor metabolizer", which affected metabolism of eleven prescribed drugs. The second case had "CYP2D6 rapid metabolizer" status affecting three prescribed medications, two of which were key drugs for managing this patient's chronic conditions. Both these patients also had VKORC1 allele *A, resulting in higher sensitivity to warfarin. All cases demonstrated a significant number of potential drug-drug interactions. Both patients with significant drug-gene interactions had a history of frequent hospitalizations (six and 23, respectively), whereas the person without impaired cytochrome P450 enzyme activity had only two acute episodes in the last 5 years, although he was older and had multiple comorbidities. Since all patients received guideline-concordant therapy from the same providers and were adherent to their drug regimen, we hypothesized that genetic polymorphism may represent an additional risk factor for higher hospitalization rates in older adults with polypharmacy. However, evidence to support or reject this hypothesis is yet to be established. Studies evaluating clinical impact of PGx testing in older adults with polypharmacy are warranted. For practical implementation of pharmacogenomics in routine clinical care, besides providing convincing evidence of its clinical effectiveness, multiple barriers must be addressed. Introduction of intelligent clinical decision support in electronic medical record systems is required to address complexities of simultaneous drug-gene and drug-drug interactions in older adults with polypharmacy. Physician training, clear clinical pathways, evidence-based guidelines, and patient education materials are necessary for unlocking full potential of pharmacogenomics into routine clinical care of older adults.

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Mendeley readers

The data shown below were compiled from readership statistics for 77 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 77 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 14 18%
Student > Ph. D. Student 13 17%
Student > Bachelor 10 13%
Other 7 9%
Student > Doctoral Student 6 8%
Other 16 21%
Unknown 11 14%
Readers by discipline Count As %
Medicine and Dentistry 24 31%
Pharmacology, Toxicology and Pharmaceutical Science 13 17%
Biochemistry, Genetics and Molecular Biology 11 14%
Agricultural and Biological Sciences 5 6%
Computer Science 4 5%
Other 8 10%
Unknown 12 16%