Scientific evidence indicates that pharmacogenomics − the study of how genes affect a person’s response to drugs− may improve patient safety. This relatively new field combines pharmacology (the science of drugs) and genomics (the study of genes and their functions) to prescribe effective, safe medications and doses that will be tailored to a person’s genetic makeup. Children’s Minnesota is proud to offer this program as one of only a few in the country.
The pharmacogenomics program at Children’s Minnesota utilizes molecular testing to analyze genes in order to understand how a patient will metabolize medications. Test results are analyzed by the team and used to adjust medications and dosages to maximize efficacy from a drug while minimizing side effects and reducing the number of medication trials. Genetic testing is considered along with other factors including patient age, weight, disease process, use of other medications, health behaviors and environment. Because the genes that impact liver metabolism do not change with age, the test results can be used for both current concerns and for future conditions.
“In my opinion, we have the top pharmacogenetics program in the Upper Midwest,” Bruce Bostrom, MD, Children’s Minnesota Hematology Oncology.
Dr. Gregornik and his team pioneer pediatric pharmacogenomics at Children’s Minnesota
In 1995, David Gregornik, PharmD, completed a specialty residency in Pediatric Pharmacotherapy at St. Jude Children’s Research Hospital in Memphis, Tenn., a pioneer in the field of pharmacogenomics. He continued on at St. Jude’s for 18 years where he provided advanced clinical pharmacy care to children with cancer and undergoing bone marrow transplant. In 2016, he joined Children’s Minnesota where he established the pharmacogenomics program. Dr. Gregornik continues to expand the program through participation in a consortium of pediatric systems from around the country.
“For many years, I’ve worked with pediatric patients undergoing chemotherapy, helping to predict their response to prescribed medication including their risk for toxicity. By partnering with oncologists, I’m able to support patients in getting the right medication and dosing for optimal benefit while minimizing side effects,” said Dr. Gregornik.
The second most common reason, after cancer, patients are referred to this program include behavioral health concerns where many medications take four to six weeks to show efficacy. Through using genetic data, along with the patient’s history and condition, Dr. Gregornik can work with health care providers to make more targeted recommendations for drugs and dosage.
“Kids experiencing depression or other mental health concerns can’t wait over a month to find out whether their medication will control their condition. In many cases, we’re able to reduce the burden of trial and error through data-driven predictions,” said Dr. Gregornik.
Pharmacogenomics program referral process
Referrals are triaged to ensure the patient is a good fit for pharmacogenomics. In the first appointment, the team captures a complete medical history and evaluates the patient’s goals and experience with medications. In the second visit, if testing is recommended, Dr. Gregornik evaluates the results while focusing on the questions from the initial visit. The team provides an in-depth analysis and recommendation for the referring provider.
“Our work complements the referring clinician’s care plan. We work closely together to ensure that prescribed medications are efficient, effective and don’t cause undo side effects,” said Dr. Gregornik.
Pharmacogenomics program services offered
The pharmacogenomics program offers a number of services including:
- Genetic testing
- Education to clinical staff and presentations to local clinics
- Consultations with clinicians about drug selection and dosing
Testing is key to data-driven predictions and, in many cases, isn’t covered by insurance. The pharmacogenomics team at Children’s Minnesota recognizes the need to reduce out-of-pocket costs and testing turnaround time, and is working to bring testing in-house by the end of the year.
Test results benefit patients in the future
Within the Upper Midwest, Children’s Minnesota pharmacogenomics program is the only pediatric-focused program. Knowing that genetic testing can provide insights as a child grows, the pharmacogenomics team has ensured that results will follow a patient through their Children’s Minnesota electronic medical record (EMR). Special programming was developed to trigger an alert when a medication is added to a patient’s EMR record.
“Eventually, as our medical records begin to share more and more information, the benefit of our programming will ensure that a patient who’s invested in genetic testing will benefit from it throughout their lifetime,” Said Dr. Gregornik.
For a consult or patient referral, call 612-813-7240.