(1251) Initiating a Clinical Pharmacist-mediated Personalized Medicine Service in India

Objectives: Develop a clinical pharmacist-mediated personalized medicine service that facilitates the translation of pharmacogenetic test results into actionable insights by engaging all stakeholders i.e., the patients, prescribers, genetic testing laboratories and clinical pharmacists.

Methods: A pharmacogenetic testing company in India was approached and approval was obtained from its founders to initiate a clinical pharmacist-mediated personalized medicine service. Awareness was created in the prescribers & patients about the availability/importance of pharmacogenetic testing. Pharmacogenetic panel testing was done reactively in patients taking medications which have pharmacogenomic significance and were responding abnormally. The clinical pharmacist interpreted the results and a physician friendly report was generated with actions that could be taken to address the effect of pharmacogenes on drugs. Testing was also done pre-emptively in healthy individuals to identity any variants and inform the future pharmacotherapy decisions. At all stages in the process, patient information and their data was kept secure and confidential following the standard protocols.

Results: A total of 11 unique pharmacogenetic variants were observed across the 20 patients who were tested reactively. These variants were associated with genes such as CYP2C19, VKORC1, CYP2C9, CYP3A5, HLA B, G6PD, and CYP2C9, and have been known to impact the response of drugs such as Clopidogrel, Citalopram, Escitalopram, Warfarin, Tacrolimus, Carbamazepine and Glimepiride. Recommendations for personalized prescribing and dosing strategies have been provided according to Clinical Pharmacogenetics Implementation Consortium guidelines.
Pre-emptive pharmacogenetic screening performed in 59 individuals revealed the presence of 13 clinically significant pharmacogenes. The most prevalent gene was G6PD (36.2%), followed by CYP2C19 (18.6%), CYP2D6 (10.4%), CYP2C9 (10.4%), OPRM1 (5.4%), VKORC1 (1.92%), and HLA-B*5701 (0.28%). 86.4% of them had actionable genotypes which could affect the safety and efficacy of treatment.

Conclusions: It was found that pre-emptive and reactive pharmacogenetic testing can identify clinically significant pharmacogenes in the Indian population, identify patients at risk of developing adverse drug reaction or sub optimal/no response. If implemented, this service can help prescribers take an informed decision regarding the choice of drug, dose of drug and tailor the prescription specific to each individual patient.