Pharmacogenomics Offers Personalized Care for Older Adults

Many of the patients served by Cleveland Clinic’s Center for Geriatric Medicine (CGM) have behavioral and psychological symptoms of dementia (BPSD). These manifestations reduce quality of life for patients, they are stressful for families and often difficult for physicians to manage.

“Historically, we have prescribed medications such as antidepressants to manage manifestations of BPSD, without knowing which ones would work best for the patient,” says geriatrician Saket Saxena, MD. “We often struggle with their lack of efficacy and side effects. We also know that effectiveness of these medications and the propensity to have side effects depends, in part, on an individual’s genetic makeup.”

Early this year, the CGM started to collaborate with pharmacogenomics specialist Jennifer Hockings, PharmD, PhD, at Cleveland Clinic’s Pharmacogenomics Clinic.

Why geriatrics?

“The geriatric population is an ideal group to have pharmacogenomics testing done because we often have patients who are on multiple medications,” says Dr. Saxena. “It is helping us with our clinical decision making process with these patients.”

Now, working with Dr. Hockings’ team, CGM physicians can gather evidence for which antidepressant or antipsychotic medication is best aligned with the patient’s pharmacogenomics profile, thus increasing chances of responding and minimizing the risk of side effects for the individual.

This summer, the CGM put a new workflow in place to identify patients who would benefit the most from visiting the Pharmacogenomics Clinic and created patient educational materials about how the testing works. The goal is to ensure that patients fully understand the testing and the information it provides so they can decide if they wish to pursue it or not. Patients then provide their consent for the testing.

“There are many factors that influence how a patient will respond to a medication, including age and genetic makeup,” says geriatric pharmacist Gina Ayers, PharmD, who helped to create the educational materials for CGM patients. “Pharmacogenomics provides us with additional insight regarding a patient’s response to certain medications. This information allows us to personalize medicine for our patients so we can deliver the best care possible.”

Dr. Saxena says the testing involves a simple cheek swab from a patient’s mouth. Once patients consent and go to an appointment at the clinic to have the test, it takes about two week for the results to be uploaded to their medical record. Their physician can then go into their record at the patient’s next appointment and work with them to determine which medications could be most effective for their medical needs.

The Cleveland Clinic Pharmacogenomics Clinic can help physicians:

• Avoid prescribing a medication that may lead to adverse reactions.
• Predict who may get little or no relief from using certain medications.
• Tailor medication therapy and eliminate unnecessary and ineffective prescriptions, replacing them with more effective medications.

“In the first few months of referring our patients to this service, we are finding that many are very accepting of the testing,” says Dr. Saxena. “We are now working with our patients to start changing their meds based on evidence and recommendations from test results. This is a true innovation in care.”

What’s next?

Dr. Saxena says the CGM team is now expanding and validating the criteria it is using to refer patients for the testing so it can improve the process between Geriatrics and the Pharmacogenomics Clinic to make it even easier for patients. The CGM will also research patient outcomes. “We want to do a full study of the data and see how effectively we are using the pharmacogenomics information for our patients,” he explains.

Dr. Hockings explains further, “Each person has a unique clinical situation in terms of disease state, drugs being taken and goals for their care. At this point, the majority of patients coming to the Pharmacogenomics Clinic are getting tested for medications related to depression, anxiety and chronic pain, but testing abilities continue to evolve and offer new information all the time.”

She says there is also some good news to report. In October, United Healthcare started covering pharmacogenomics testing for patients diagnosed with anxiety and depression whose medication(s) has failed to help them. And Medicare is also evaluating coverage of pharmacogenomics testing under certain circumstances. Dr. Hockings is hopeful that additional insurance companies will follow suit, and that they will begin to cover pharmacogenomics testing for other indications, including medications for chronic pain and cardiovascular disease.