Assessment Of The Clinical Utility Of Pharmacogenomic Testing On Drug Utilization In A High Risk Patient Population

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Assessment of the Clinical Utility of Pharmacogenomic Testing on Drug Utilization in a High-risk Patient Population

Author : Sarah Marie Villarreal
Publisher :
ISBN 13 :
Total Pages : 244 pages
Book Rating : 4.:/5 (961 download)

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Book Synopsis Assessment of the Clinical Utility of Pharmacogenomic Testing on Drug Utilization in a High-risk Patient Population by : Sarah Marie Villarreal

Download or read book Assessment of the Clinical Utility of Pharmacogenomic Testing on Drug Utilization in a High-risk Patient Population written by Sarah Marie Villarreal and published by . This book was released on 2016 with total page 244 pages. Available in PDF, EPUB and Kindle. Book excerpt: The potential benefits of incorporating pharmacogenomic (PGx) testing into clinical practice include minimizing adverse drug reactions (ADRs) and improving clinical outcomes based on genetic differences of individuals. Despite significant advances in bridging PGx from bench-to-bedside, there have been slower efforts to incorporate PGx testing into routine clinical practice due to the lack of robust evidence for clinical utility and convincing studies demonstrating improved health outcomes. The UPGRADE Registry, an interim, prospective, observational trial aimed at assessing several key aspects of PGx testing: 1) determining the total number of high-risk patients that had at least one drug change and its impact on patients; 2) describing the genetic polymorphisms representing populations in the US and Puerto Rico; 3) to evaluate the association between race/ethnicity and the percentage of drug changes; and 4) identifying individual factors (age, gender, co-morbidities, number of drugs, and race/ethnicity) affecting the number of drug changes implemented by practitioners. Approximately 25% of the entire cohort underwent drug changes after PGx testing results (defined as dose modifications, drug substitutions, and drug discontinuations); however, almost 50% of patients with adverse drug reactions (ADRs) with drug-drug or drug-gene interactions experienced subsequent therapeutic modifications. The ADR cohort reported herein also experienced significant decreases in the number of ADRs after PGx testing recommendations. The major subset of the UPGRADE population (95%) was characterized as experiencing a lack of drug activity (LOA); only 25% of these patients experienced any therapeutic drug modification. The UPGRADE registry confirms currently published literature that provides additional support to the distribution of polymorphic changes in drug metabolizing enzymes within the US population. There were no differences in the percentage of drug changes that occurred when comparing differing ethnicities, indicating a lack of healthcare disparity within this high-risk population. Several factors were identified as independent predictors of the number of drug changes. A positive relationship, (i.e. increasing the likelihood of drug change) was seen with number of drugs, gastrointestinal disorders, and hepatobiliary diseases. This prospective, observational, study demonstrated the potential of drug modifications in prevention of subsequent ADRs and improving LOA based on PGx testing of drug metabolizing enzymes. Additional education to clinical providers regarding the use and benefit of PGx testing is warranted based on guidance provided by our PGx testing results and a lack of subsequent drug changes.

Pharmacogenomics

Author : Yui-Wing Francis Lam
Publisher : Academic Press
ISBN 13 : 0123983037
Total Pages : 515 pages
Book Rating : 4.1/5 (239 download)

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Book Synopsis Pharmacogenomics by : Yui-Wing Francis Lam

Download or read book Pharmacogenomics written by Yui-Wing Francis Lam and published by Academic Press. This book was released on 2013-02-12 with total page 515 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pharmacogenomics: Challenges and Opportunities in Therapeutic Implementation includes discussions and viewpoints from the academic, regulatory, pharmaceutical, clinical, socio-ethical and economic perspectives. Each chapter presents an overview of the potential or opportunity within the areas discussed and also outlines foreseeable challenges and limitations in moving pharmacogenomics into drug development and direct therapeutic applications. This edited book contains review questions for a more in-depth analysis of the implications of pharmacogenomics and discussion points to generate ideas on best to move the field forward. Clinical pearls and case studies are used to illustrate real-life experiences and both successful and unsuccessful applications. Tables, figures, and annotations are included throughout the book to facilitate understanding and further reference. - Multi-contributed book and chapters are written by contributors who are experts in their field - Provides perspectives from those involved in all aspects of pharmacogenomics—including academic, regulatory, economic, industry and medical—to illustrate how all of the pieces fit together and where the challenges may be - Includes case studies of both successful and unsuccessful applications so readers can consider the potential and challenges in moving the science into drug development and direct therapeutic applications - Chapters contain discussion questions and clinical pearls and enable readers to reflect on how to move pharmacogenomics forward and apply these observations and useful tips to their own work and research

Pharmacogenomics in Clinical Practice

Author : Dragan Primorac
Publisher : Springer Nature
ISBN 13 : 3031459032
Total Pages : 484 pages
Book Rating : 4.0/5 (314 download)

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Book Synopsis Pharmacogenomics in Clinical Practice by : Dragan Primorac

Download or read book Pharmacogenomics in Clinical Practice written by Dragan Primorac and published by Springer Nature. This book was released on 2024-01-04 with total page 484 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a practically applicable guide to the applications of pharmogenomics across medicine. Background information is provided on the mechanisms associated with membrane transporters, drug-metabolizing enzymes and their importance in pharmagenomics. Detailed guidance is subsequently presented on how to apply these techniques in disciplines including cardiology, gastroenterology, oncology, transplantation surgery, infectious diseases, anesthesia and analgesia, neurology, psychiatry, primary care, and public health. Clear easy-to-follow instructions are given on how to use big data technologies and public health databases in day-to-day clinical practice. Pharmacogenomics in Clinical Practice concisely covers how pharmacogenomic technologies and techniques can be applied in daily medical practice. It is therefore an ideal up-to-date resource for any medical practitioner, trainee or researcher across all medical disciplines who want to better understand how to use these techniques.

Pharmacogenomics and Public Health

Author : W. Burke
Publisher :
ISBN 13 : 9783805590594
Total Pages : 0 pages
Book Rating : 4.5/5 (95 download)

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Book Synopsis Pharmacogenomics and Public Health by : W. Burke

Download or read book Pharmacogenomics and Public Health written by W. Burke and published by . This book was released on 2009 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The use of pharmacogenomic testing to improve the safety and efficacy of drug treatment represents a promising potential benefit of genomic research. Yet, the limited predictive value of many proposed pharmacogenomic tests and the uncertainty of their clinical utility make it difficult to forecast the public health impact of pharmacogenomics. It is essential, however, that relevant scientific, social, and policy issues are addressed to optimize the potential benefits to patients and the public's health. These include careful consideration of incentives - such as research funding, partnership development, and reimbursement mechanisms - and regulatory oversight. The needs and expectations of both clinicians and patients must be identified, and the potential for unanticipated consequences must be considered. Pharmacogenomics and Public Health illustrates the wide range of scientific, ethical and social issues to be considered as the field develops. With its broad, multidisciplinary perspective it provides researchers, policy makers, and health care leaders with important information on an emerging technology that they will be called upon to evaluate either now or in the near future.

Exploring Strategies to Optimize the Value of Pharmacogenomic Testing

Author : M. Ragan Hart
Publisher :
ISBN 13 :
Total Pages : 110 pages
Book Rating : 4.:/5 (16 download)

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Book Synopsis Exploring Strategies to Optimize the Value of Pharmacogenomic Testing by : M. Ragan Hart

Download or read book Exploring Strategies to Optimize the Value of Pharmacogenomic Testing written by M. Ragan Hart and published by . This book was released on 2018 with total page 110 pages. Available in PDF, EPUB and Kindle. Book excerpt: The emergence and continual advancement of genomic technologies offer numerous areas that warrant a critical appraisal for integrating new health care services to increase access and improve outcomes for patients. This dissertation examines two strategies in the context of pharmacogenomics (PGx) testing. In the Overall Introduction, we initially focus on identifying clinical utility and economic evidence gaps necessary to inform appropriate clinical adoption of PGx testing across diverse healthcare settings. In Chapter 1, we report our findings from an analysis of real-world evidence from a commercial PGx knowledge resource, which is comprised of data from patients who have undergone PGx testing. Additionally, we characterize gene-drug pair level of evidence as developed by expert groups, and present associated predictive factors that may inform clinical actionability. Following this, in Chapter 2, we focus on a hypothetical clinical cohort of acute coronary syndrome patients undergoing percutaneous coronary intervention. We use decision modeling methods to estimate the projected cost-effectiveness of a multi-gene panel to guide two treatment decisions for this clinical cohort from the payer perspective. We describe influential parameters in the model, discuss limitations of this work, and denote implications to health policy decision making. In the Overall Conclusions, we summarize and describe future considerations. To increase appropriate clinical PGx testing adoption, we provide evidence that healthcare entities may wish to consider the use of a commercially-developed PGx knowledge resource solution in lieu of delaying implementation awaiting publicly available PGx knowledge resource solutions. Additionally, for the aforementioned patient cohort, we provide evidence that the multi-gene panel estimates are projected to be cost-effective at a $100,000 willingness-to-pay threshold when compared to either a single-gene panel or to no gene testing. These findings build upon the available economic evidence for multi-gene panels that payer decision makers may consider during their health technology assessment evaluations to determine inclusion of covered services within their medical policies. Finally, the contents of this dissertation contribute to the broader discourse regarding value assessments in the interplay between precision medicine and clinical genomics.

Pharmacogenomic Testing in Current Clinical Practice

Author : Alan H. B. Wu
Publisher : Springer Science & Business Media
ISBN 13 : 1607612836
Total Pages : 276 pages
Book Rating : 4.6/5 (76 download)

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Book Synopsis Pharmacogenomic Testing in Current Clinical Practice by : Alan H. B. Wu

Download or read book Pharmacogenomic Testing in Current Clinical Practice written by Alan H. B. Wu and published by Springer Science & Business Media. This book was released on 2011-02-08 with total page 276 pages. Available in PDF, EPUB and Kindle. Book excerpt: While the basic principles of personalized medicine and pharmacogenomics has been covered by numerous texts, there are none to date that focuses on the specific tests themselves that are in current clinical practice and those that are being proposed for implementation in the near future. Pharmacogenomic Testing in Current Clinical Practice: Implementation in the Clinical Laboratory focuses almost entirely on the specifics of each test that is needed to implement these tests into a clinical laboratory. This volume presents the first compilation of the tests currently in routine clinical use. The chapter authors of this unique and invaluable title comprise a range of renowned authorities and investigators who have conducted the essential clinical trials necessary to justify pharmacogenomic testing today. The book is divided into four parts: Basic Concepts, Specific Pharmacogenomic Targets, Drugs that Cause Delayed Hypersensitivity, and Miscellaneous Drugs. Each author provides a pharmacologic background on the target drug, the need for pharmacogenomic testing, and how results can be translated into clinical decisions. Where appropriate, case studies are given to illustrate typical clinical scenarios. An extensive bibliography is provided so that the reader can refer to the original studies. This well-designed resource will appeal to clinical laboratory directors who are contemplating or assigned the task of establishing a pharmacogenomics laboratory and a wide range of clinicians who must interpret results of testing. Focused and immensely useful, Pharmacogenomic Testing in Current Clinical Practice: Implementation in the Clinical Laboratory is a timely and outstanding contribution to the literature and will be instrumental in defining this rapidly growing field.

Pharmacogenomics in Psychiatry

Author : M. Schwab
Publisher : Karger Medical and Scientific Publishers
ISBN 13 : 3805594992
Total Pages : 148 pages
Book Rating : 4.8/5 (55 download)

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Book Synopsis Pharmacogenomics in Psychiatry by : M. Schwab

Download or read book Pharmacogenomics in Psychiatry written by M. Schwab and published by Karger Medical and Scientific Publishers. This book was released on 2010-06-25 with total page 148 pages. Available in PDF, EPUB and Kindle. Book excerpt: In recent years, there have been major developments in the fields of pharmacogenetics and pharmacogenomics, with the potential to make drug treatments in psychiatric medicine more effective. However, improvements in drug efficacy and tolerability, as well as finding the optimal dosage, can only be realized if in vivo mechanisms of drug action and ADME (absorption, distribution, metabolism, excretion) processes (pharmacokinetics) of psychopharmacological agents are better understood. In this volume, current progress and perspectives in pharmacogenetic testing of drug-metabolizing enzymes, drug transporters and other drug targets involved in the response to psychotropic agents are described extensively. This provides a timely overview of what has been achieved in the area of psychiatric pharmacogenomics alongside some promising directions and perspectives for future research.Psychiatrists, general medical doctors as well as pharmacologists and clinical pharmacologists will find new insights into the development and applications of pharmacogenomics in psychiatry.

The Evidence-Based Guide to Antidepressant Medications

Author : Anthony J. Rothschild
Publisher : American Psychiatric Pub
ISBN 13 : 1585629804
Total Pages : 426 pages
Book Rating : 4.5/5 (856 download)

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Book Synopsis The Evidence-Based Guide to Antidepressant Medications by : Anthony J. Rothschild

Download or read book The Evidence-Based Guide to Antidepressant Medications written by Anthony J. Rothschild and published by American Psychiatric Pub. This book was released on 2012-09-24 with total page 426 pages. Available in PDF, EPUB and Kindle. Book excerpt: The second book in the Evidence-Based Guides series, The Evidence-Based Guide to Antidepressant Medications, provides a clear reference to the current knowledge and evidence base for the use of antidepressants among a variety of patients across a wide range of disorders. Chapters within this guide are authored by experts in their respective areas of practice, and synthesize a large amount of medical literature into a comprehensive, yet understandable, concise, reader-friendly guide. Each chapter covers both the FDA-approved and off-label use of antidepressant medications and the evidence base for their use. Each chapter also features useful tables pertaining to specific topics, such as summaries of uses and efficacy, and important clinical pearls of wisdom in the Key Clinical Concepts. Topics covered in chapters within this text include: Use of selective serotonin reuptake inhibitors, MAOIs, and tricyclic antidepressants in major depressive disorder, bipolar depression, psychotic depression, and treatment-resistant depression. Acute management of anxiety disorders, obsessive-compulsive disorder, and specific phobias through antidepressant use. Use of antidepressant medication in medically ill patients, such as those with cardiovascular, pulmonary, gastrointestinal, renal, and endocrine diseases, as well as cancer, chronic pain, HIV, burns and hospital-based trauma. Developmental considerations necessary to keep in mind when prescribing antidepressants to children and adolescents, along with an outline of controlled studies and their special attention to safety. Medication management in geriatric patients, including antidepressant use among depressed elderly patients with dementia, stroke, or Parkinson's disease. Risks and benefits of prescribing antidepressants during pregnancy and lactation. Together, the authors have synthesized a large amount of medical literature into a comprehensive, yet understandable, concise, reader-friendly guide. The Evidence-Based Guide to Antidepressant Medications is a must-have reference for psychiatrists and other practicing clinicians, residents in training, psychiatric nurses, social workers and researchers.

Textbook of Personalized Medicine

Author : Kewal K. Jain
Publisher : Humana Press
ISBN 13 : 1493925539
Total Pages : 762 pages
Book Rating : 4.4/5 (939 download)

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Book Synopsis Textbook of Personalized Medicine by : Kewal K. Jain

Download or read book Textbook of Personalized Medicine written by Kewal K. Jain and published by Humana Press. This book was released on 2015-03-17 with total page 762 pages. Available in PDF, EPUB and Kindle. Book excerpt: Advances in the technology used in personalized medicine and increased applications for clinical use have created a need for this expansion and revision of Kewal K. Jain’s Textbook of Personalized Medicine. As the first definitive work on this topic, this book reviews the fundamentals and development of personalized medicine and subsequent adoptions of the concepts by the biopharmaceutical industry and the medical profession. It also discusses examples of applications in key therapeutic areas, as well as ethical and regulatory issues, providing a concise and comprehensive source of reference for those involved in healthcare management, planning and politics. Algorithms are included as a guide to those involved in the management of important diseases where decision-making is involved due to the multiple choices available. Textbook of Personalized Medicine, Second Edition will serve as a convenient source of information for physicians, scientists, decision makers in the biopharmaceutical and healthcare industries and interested members of the public.

Evolution of Translational Omics

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309224187
Total Pages : 354 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis Evolution of Translational Omics by : Institute of Medicine

Download or read book Evolution of Translational Omics written by Institute of Medicine and published by National Academies Press. This book was released on 2012-09-13 with total page 354 pages. Available in PDF, EPUB and Kindle. Book excerpt: Technologies collectively called omics enable simultaneous measurement of an enormous number of biomolecules; for example, genomics investigates thousands of DNA sequences, and proteomics examines large numbers of proteins. Scientists are using these technologies to develop innovative tests to detect disease and to predict a patient's likelihood of responding to specific drugs. Following a recent case involving premature use of omics-based tests in cancer clinical trials at Duke University, the NCI requested that the IOM establish a committee to recommend ways to strengthen omics-based test development and evaluation. This report identifies best practices to enhance development, evaluation, and translation of omics-based tests while simultaneously reinforcing steps to ensure that these tests are appropriately assessed for scientific validity before they are used to guide patient treatment in clinical trials.

Psychiatric Pharmacogenomics

Author : David Mrazek
Publisher : Oxford University Press
ISBN 13 : 0195367294
Total Pages : 276 pages
Book Rating : 4.1/5 (953 download)

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Book Synopsis Psychiatric Pharmacogenomics by : David Mrazek

Download or read book Psychiatric Pharmacogenomics written by David Mrazek and published by Oxford University Press. This book was released on 2010-06-10 with total page 276 pages. Available in PDF, EPUB and Kindle. Book excerpt: Psychiatric Pharmacogenomics is a book written to help clinicians to use pharmacogenomic testing to improve the pharmacotherapy that they provide for their patients. It is designed to teach clinicians how to order pharmacogenomic tests and interpret the results. Clinical examples are used to underscore the specific indications for pharmacogenomic testing and to clarify the clinical usefulness of identifying atypical genotypes that result in problematic responses to medication. The first section of the book begins with a basic review of molecular genetics. Additionally, the book also includes an extensive glossary of technical terms associated with molecular genetics and pharmacogenomics. The clinical utility of pharmacogenomic testing is demonstrated throughout the book by describing the implications of genetic variations for the care of individual patients. The second section of the book is organized into fourteen chapters that each focus on the clinical implications of testing for specific genes for which variants have been associated with either therapeutic response or side effects of psychotropic medications. Each of these chapters is structured in the same manner and involves a description of the gene and its significant variants. Each chapter also includes one or more clinical vignettes. The third section of the book discusses the clinical usefulness of pharmacogenomic testing, ethical issues associated with pharmacogenomic testing, and provides predictions for the future development of more sophisticated pharmacogenomic testing.

The Evidence-Based Guide to Antipsychotic Medications

Author : Anthony J. Rothschild
Publisher : American Psychiatric Pub
ISBN 13 : 1585629294
Total Pages : 395 pages
Book Rating : 4.5/5 (856 download)

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Book Synopsis The Evidence-Based Guide to Antipsychotic Medications by : Anthony J. Rothschild

Download or read book The Evidence-Based Guide to Antipsychotic Medications written by Anthony J. Rothschild and published by American Psychiatric Pub. This book was released on 2010-01-12 with total page 395 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Evidence-Based Guide to Antipsychotic Medications is designed to provide both clinicians and residents with focused, comprehensive, and clinically relevant information regarding the use of antipsychotic medications to treat a broad range of psychiatric conditions -- from mood and anxiety disorders to substance abuse, personality disorders, and schizophrenia. The volume editor is a renowned psychiatrist and author with more than 25 years of experience in both clinical and research settings diagnosing and treating patients with mood and psychotic disorders. In addition, each of the volume's 13 contributors is an expert with many years of clinical experience to draw on.The book is down-to-earth and reader-friendly and is structured for maximal utility in both coverage and format: Key Clinical Points cap each chapter, synthesizing and summarizing the knowledge you can take away, and serving both as a refresher for those using the book as a reference and as a study aid to master the material. Both FDA-approved and off-label use of antipsychotic medications are addressed, reflecting the reality of clinical practice on the front lines. Use of antipsychotic medications in both the pediatric and geriatric populations, a potentially controversial subject, is addressed in a nonsensational, straight-forward manner. The Appendixes provide a wealth of information in tabular format, including drug tables (names, strengths, formulations, pharmacokinetics, and dosing); advice on initiating and monitoring antipsychotic medications; common side effects and their management; and special considerations for use during pregnancy and breastfeeding. The Evidence-Based Guide to Antipsychotic Medications is the first in a new series that strives to take evidence-based psychiatry from gold standard to standard practice. Scientifically up-to-date and rigorous, yet accessible and easy to understand, this volume stands alone as an indispensable resource on the topic.

Generating Evidence for Genomic Diagnostic Test Development

Author : Institute of Medicine
Publisher : National Academies Press
ISBN 13 : 0309211042
Total Pages : 106 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis Generating Evidence for Genomic Diagnostic Test Development by : Institute of Medicine

Download or read book Generating Evidence for Genomic Diagnostic Test Development written by Institute of Medicine and published by National Academies Press. This book was released on 2011-07-27 with total page 106 pages. Available in PDF, EPUB and Kindle. Book excerpt: Ten years after the sequencing of the human genome, scientists have developed genetic tests that can predict a person's response to certain drugs, estimate the risk of developing Alzheimer's disease, and make other predictions based on known links between genes and diseases. However, genetic tests have yet to become a routine part of medical care, in part because there is not enough evidence to show they help improve patients' health. The Institute of Medicine (IOM) held a workshop to explore how researchers can gather better evidence more efficiently on the clinical utility of genetic tests. Generating Evidence for Genomic Diagnostic Test Development compares the evidence that is required for decisions regarding clearance, use, and reimbursement, to the evidence that is currently generated. The report also addresses innovative and efficient ways to generate high-quality evidence, as well as barriers to generating this evidence. Generating Evidence for Genomic Diagnostic Test Development contains information that will be of great value to regulators and policymakers, payers, health-care providers, researchers, funders, and evidence-based review groups.

Comparative Effectiveness Approaches to Evaluate Pharmacogenomic Technology

Author : Joshua A. Roth
Publisher :
ISBN 13 :
Total Pages : 136 pages
Book Rating : 4.:/5 (891 download)

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Book Synopsis Comparative Effectiveness Approaches to Evaluate Pharmacogenomic Technology by : Joshua A. Roth

Download or read book Comparative Effectiveness Approaches to Evaluate Pharmacogenomic Technology written by Joshua A. Roth and published by . This book was released on 2012 with total page 136 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recent advances in genomic science present opportunities to "personalize" pharmaceutical treatments and improve health outcomes. However, such improvements are impeded by sparse evidence assessing pharmacogenomic technology clinical utility. This uncertainty constrains stakeholder decision-making, and has resulted in both sub-optimal and premature clinical translation. Timely assessment of health outcomes and clinical utility is critical to overcoming these translational issues. Comparative effectiveness research (CER) can meet this need by applying epidemiologic, health economic, and bio-statistical methods to generate timely evidence in "real world" conditions. Objective To demonstrate the utility of CER methods to evaluate pharmacogenomic technology in case studies in warfarin therapy, lung cancer, and breast cancer. First, I utilize a case-control design to evaluate the association between genetic variants and risk of major bleeding in warfarin therapy patients. Second, I conduct a value of information (VOI) analysis to assess the value of a future trial investigating the clinical utility of ERCC1-guided adjuvant chemotherapy in lung cancer. Third, I explore the potential application of benefit-risk modeling to inform regulatory review of pharmacogenomic technology, with a specific demonstration in gene-expression profiling in early-stage breast cancer. Results In the evaluation of warfarin pharmacogenomics, I demonstrate the first association between CYP4F2 variants and decreased risk of major bleeding, and provided exploratory evidence suggesting differential CYP2C9 variant bleeding risk based on geographic setting. In the ERCC1 VOI analysis, I demonstrate that a trial is expected to cost $30m, create value of $80m, and thus provide $50m in societal net-benefit. In my evaluation of regulatory benefit-risk modeling for pharmacogenomic technology, I examine a range of insights that can be gained through incorporation of systematic and quantitative evaluative methods in regulatory review processes. In each case study, CER methods provide key evidence about health outcome impacts of pharmacogenomic technologies. These results have direct implications for clinical utility, and can inform stakeholder decision-making. These types of CER applications will likely play an important role in future assessment and translation of pharmacogenomic technologies due to accelerating research and development, and inability of traditional controlled trial designs to provide timely, adaptable, and readily applicable evidence.

Cardiovascular Genetics and Genomics

Author : Dhavendra Kumar
Publisher : Springer
ISBN 13 : 3319661140
Total Pages : 921 pages
Book Rating : 4.3/5 (196 download)

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Book Synopsis Cardiovascular Genetics and Genomics by : Dhavendra Kumar

Download or read book Cardiovascular Genetics and Genomics written by Dhavendra Kumar and published by Springer. This book was released on 2018-01-17 with total page 921 pages. Available in PDF, EPUB and Kindle. Book excerpt: This title reflects the exponential growth in the knowledge and information on this subject and defines the extensive clinical translation of cardiovascular genetics and genomics in clinical practice. This concise, clinically oriented text is targeted at a broad range of clinicians who manage patients and families with a wide range of heterogeneous inherited cardiovascular conditions. Cardiovascular Genetics and Genomics: Principles and Clinical Practice includes a concise and clear account on selected topics written by a team of leading experts on clinical cardiovascular genetics. Each chapter include key information to assist the clinician and case histories have been incorporated to reflect contemporary practice in clinical cardiovascular genetics and genomics. Therefore this will be of key importance to all professionals working in the discipline, from clinicians and trainees in cardiology, cardiac surgery, electrophysiology, immunology through geneticists, nursing staff and those involved in precision medicine.

Assessment of Clopidogrel Discontinuation Rates Following Pharmacogenomic Testing in a High-risk Patient Population

Author : David Anthony Huggar
Publisher :
ISBN 13 :
Total Pages : 102 pages
Book Rating : 4.:/5 (993 download)

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Book Synopsis Assessment of Clopidogrel Discontinuation Rates Following Pharmacogenomic Testing in a High-risk Patient Population by : David Anthony Huggar

Download or read book Assessment of Clopidogrel Discontinuation Rates Following Pharmacogenomic Testing in a High-risk Patient Population written by David Anthony Huggar and published by . This book was released on 2017 with total page 102 pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: Advancements in the science and technology of pharmacogenomics (PGx) offer a unique opportunity for clinicians to improve care efficiency. Clopidogrel is an antiplatelet agent commonly used for treatment of complications from coronary artery disease (CAD). Clopidogrel is a pro-drug and keenly dependent on cytochrome P450 enzymes for bioactivation to exert its antiplatelet effects. Poor CYP2C19 metabolic activity has been associated with reduced antiplatelet effects and worse cardiovascular outcomes. As a result, the FDA requires a warning of this association be included in the drug label for clopidogrel. This thesis work examined whether clinicians adhere to FDA recommendation of using an alternative antiplatelet therapy when persons taking clopidogrel were identified as CYP2C19 poor metabolizers. Methods: This retrospective, interim analysis of the UPGRADE Registry identified subjects taking clopidogrel prior to undergoing PGx testing. Clopidogrel discontinuation rates were then assessed by medication reconciliation reports at follow-up in the 90-days following receipt of PGx results. Discontinuation rates of subjects identified as CYP2C19 poor metabolizers (PM) were compared to those identified as non-poor metabolizers (non-PM) (ultrarapid, extensive, or intermediate). Results: Overall, 1,753 subjects were included in the analysis. The median age of subjects was 75 years, and distribution of CYP2C19 phenotypes mirrored global estimates. Forty-three subjects were identified as PM (2.5%), and 1,710 were identified as non-PM (97.5%). No difference in discontinuation rates was observed between PM and non-PM subjects (2.3% vs. 1.9%; OR=0.37, 95% CI 0.05-2.98). Furthermore, discontinuation rates were not affected by concomitant proton-pump inhibitor (PPI) use. Conclusion: Despite relatively robust evidence associating poor CYP2C19 function with worse outcomes in subjects taking clopidogrel, clinical uptake of related recommendations appears poor in the primary care setting. Multiple barriers to clinical uptake of the FDA’s recommendations exist. This finding maintains significant implications for future PGx recommendations.

Polypharmacy and Medicines Optimisation

Author : Martin Duerden
Publisher :
ISBN 13 : 9781909029187
Total Pages : 56 pages
Book Rating : 4.0/5 (291 download)

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Book Synopsis Polypharmacy and Medicines Optimisation by : Martin Duerden

Download or read book Polypharmacy and Medicines Optimisation written by Martin Duerden and published by . This book was released on 2013-11 with total page 56 pages. Available in PDF, EPUB and Kindle. Book excerpt: This report provides a definition of polypharmacy, considers the evidence around medicines management and concludes that there is a need for guidelines on the treatment of multi-morbidity and that clinicians need to work alongside patients to empower them to make informed decisions about their medication.