Reducing Adverse Reactions From Psychiatric Drugs
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| A pilot program at Cincinnati Children's will provide pharmacogenetic testing on 34 different psychiatric drugs to help pediatricians make decisions about drug choices. |
This summer Cincinnati Children's Hospital Medical Center will launch a pilot program to provide genetic information and electronic decision support tools to help pediatricians make safer, more effective drug choices for their patients with neuropsychiatric disorders, including mental illness, autism and Attention Deficit Hyperactivity Disorder.
The six-month pilot, which involves two local pediatric practices, is led by the Cincinnati Children's Genetic Pharmacology Service / GPS, a multidisciplinary team of experts in genetics, pharmacology, statistics, bioinformatics and education.
Formed in 2004, GPS aims to reduce adverse drug reactions caused by genetic variations and drug-drug interactions. Research indicates that adverse drug reactions kill as many as 100,000 patients annually and permanently disable or cause prolonged hospitalizations in more than 2 million others. That makes drug toxicity between the fourth and sixth leading cause of death in the United States for the overall population.
GPS, the largest pediatric pharmacogenetic clinical service in the country, has focused on neuropsychiatric drugs because they have small safety margins and a high potential for drug-drug interactions Also, certain gene variations can alter the way they are metabolized, explains Tracy Glauser, MD, who heads GPS along with Kejian Zhang, MD, MBA, director of the Molecular Genetic Laboratory at Cincinnati Children's and Sander Vinks, PharmD, PhD, director of the Cincinnati Children's Pediatric Pharmacology Research Unit.
As much as physicians would like to make prescribing decisions based on their patients' unique needs, prescribing neuropsychiatric drugs has historically been a matter of "trial and error," says Dr. Glauser, because physicians have had to base their decisions on general indicators, such as the patient's age, weight and family history of response to medications.
GPS aims to enhance decision making by providing pharmacogenetic testing on 34 different psychiatric drugs. Dr. Glauser estimates that between 20 and 25 percent of children on neuropsychiatric drugs have the potential for an adverse drug reaction because of genetic variations or the combination of drugs they are taking.
Those reactions, which can include mood swings, exhaustion, irritability or other far worse side effects, can be extremely challenging for patients and their families.
"We have the knowledge, skills and resources to help clinicians get people to the right drug and the right dose as quickly as possible and to allow patients and families to have their lives back as quickly as possible," Dr. Glauser says.
Since January 2005, more than 3,000 patients at Cincinnati Children's have benefited from GPS' genetic screening service. The team hopes that number will increase when – for the first time – the pilot makes the testing available to pediatricians.
The program being piloted "is a quantum level better" than the current service, Dr. Glauser says, because it includes a decision support tool developed by the hospital's Computational Medicine Center. While physicians using GPS testing currently receive a report assessing the implications of a particular drug, the enhanced version includes software that processes test results, overlays them with the patient's medical history and makes patient-specific drug recommendations based on evidence-based medicine coupled with drug efficacy, tolerability, safety and ease of use factors.
"The program really demonstrates the power of a multidisciplinary approach that incorporates genetics, pharmacology and bioinformatics to support health care providers and ultimately improve the health of the kids we care for. We're using teamwork and science to achieve the ultimate goal of helping kids get better."
