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      Peer Review of “Effects of Pharmacogenomic Testing in Clinical Pain Management: Retrospective Study”

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          Effects of Pharmacogenomic Testing in Clinical Pain Management: Retrospective Study

          Background The availability of pharmacogenomic (PGx) methods to determine the right drug and dosage for individualized patient treatment has increased over the past decade. Adoption of the resulting PGx reports in a clinical setting and monitoring of clinical outcomes is a challenging and long-term commitment. Objective This study summarizes an extended PGx deep sequencing panel intended for medication dosing and prescription guidance newly adopted in a pain management clinic. The primary outcome of this retrospective study reports the number of cases and types of drugs covered, for which PGx data appears to have assisted in optimal drug prescription and dosing. Methods A PGx panel is described, encompassing 23 genes and 141 single-nucleotide polymorphisms or indels, combined with PGx dosing guidance and drug-gene interaction (DGI) and drug-drug interaction (DDI) reporting to prevent adverse drug reactions (ADRs). During a 2-year period, patients (N=171) were monitored in a pain management clinic. Urine toxicology, PGx reports, and progress notes were studied retrospectively for changes in prescription regimens before and after the PGx report was made available to the provider. An additional algorithm provided DGIs and DDIs to prevent ADRs. Results Among patient PGx reports with medication lists provided (n=146), 57.5% (n=84) showed one or more moderate and 5.5% (n=8) at least one serious PGx interaction. A total of 96 (65.8%) patients showed at least one moderate and 15.1% (n=22) one or more serious DGIs or DDIs. A significant number of active changes in prescriptions based on the 102 PGx/DGI/DDI report results provided was observed for 85 (83.3%) patients for which a specific drug was either discontinued or switched within the defined drug classes of the report, or a new drug was added. Conclusions Preventative action was observed for all serious interactions, and only moderate interactions were tolerated for the lack of other alternatives. This study demonstrates the application of an extended PGx panel combined with a customized informational report to prevent ADRs and improve patient care.
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            Author and article information

            Journal
            JMIRx Med
            JMIRx Med
            JMIRxMed
            JMIRx Med
            JMIR Publications (Toronto, Canada )
            2563-6316
            Apr-Jun 2022
            3 May 2022
            : 3
            : 2
            : e37145
            Affiliations
            [1 ] The Children's Hospital of Philadelphia Philadelphia, PA United States
            Author information
            https://orcid.org/0000-0001-5534-6904
            Article
            v3i2e37145
            10.2196/37145
            10414494
            43d4a906-c80f-488f-b66e-e2cf5fe70a37
            ©Komal Rathi. Originally published in JMIRx Med (https://med.jmirx.org), 03.05.2022.

            This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIRx Med, is properly cited. The complete bibliographic information, a link to the original publication on https://med.jmirx.org/, as well as this copyright and license information must be included.

            History
            : 8 February 2022
            : 8 February 2022
            Categories
            Peer-Review Report
            Peer-Review Report

            pharmacogenomics,pain management,drug-drug interaction,ddi,pharmacy,prescriptions,genetics,genomics,drug-gene interaction,pain

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