New personalized medicine initiative enables doctors to tailor drug therapies to individual patients based on genetic profile
Newswise BALTIMORE May 14, 2013. Patients with coronary artery disease who undergo treatment at the University of Maryland Medical Center now can receive long-term therapy based on information found in their genes. As part of a new personalized medicine initiative, the medical center is offering genetic testing to help doctors determine which medication a patient should take after a stenting procedure in order to prevent blood clots that could lead to serious and potentially fatal heart attacks and strokes.
Patients with suspected heart disease undergo coronary catheterization to identify blocked or narrow arteries. Tiny tubes, or stents, are often placed in the arteries to keep them open, and, after surgery, patients typically take antiplatelet drugs, such as clopidogrel (Plavix), to prevent platelets blood cells produced in bone marrow from sticking together and forming clots.
Now, patients who undergo coronary catheterization at UMMC and the Baltimore VA Medical Center, both of which are affiliated with the University of Maryland School of Medicine, can elect to be tested for variations in a gene called CYP2C19. Up to one-fourth of the U.S. population carries at least one abnormal copy of the CYP2C19 gene, and research has shown that as a result, these individuals do not metabolize the standard anti-clotting medication clopidogrel effectively.
There is strong clinical data to support pharmacogenetic testing in regard to antiplatelet therapy, says Alan R. Shuldiner, M.D., the John L. Whitehurst Endowed Professor of Medicine, associate dean for personalized medicine and director of the Program in Personalized and Genomic Medicine at the University of Maryland School of Medicine. Its time to incorporate genetics into the complex medical decisions that we make on behalf of our patients.
In 2009, Dr. Shuldiner led a University of Maryland study, published in JAMA, which showed that patients with a CYP2C19 gene variation exhibited reduced clinical benefit from taking clopidogrel. Based on growing clinical evidence reported in Dr. Shuldiners study and others, the U.S. Food and Drug Administration issued a warning about the reduced efficacy of clopidogrel in people with the genetic variation.
Pharmacogenetic testing enables us to tailor drug treatments to individual patients based on their unique genetic makeup, or genotype, says Dr. Shuldiner, an endocrinologist and geneticist. With genotype-directed therapy, we have the ability to change the one size fits all approach to prescribing medication and ultimately improve the quality of care we provide to our patients. Patients want personalized and individualized medicine. They seek it out.
The test is performed by analyzing the patients DNA, isolated from a blood sample, in a new state-of-the-art translational genomics laboratory at the University of Maryland School of Medicine. The tests are being conducted as part of a National Institutes of Health (NIH)-funded study to determine the best way to implement genetic-testing programs. Tests are free, and because of the partnership between UMMC and the University of Maryland School of Medicine, results are available within a few hours.
Dr. Shuldiner explains that the ability to provide test results within hours is crucial because cardiac stent patients are at risk for developing blood clots and other complications soon after they have the procedure. This rapid turnaround time sets our program apart from other programs and commercial laboratories, where results may not be available for up to two weeks, he adds.
Pharmacogenomics how genes affect a persons response to drugs is a burgeoning area of research, but only a small number of hospitals in the United States have programs to offer routine genetic testing as part of their clinical practice. This new approach to patient care is part of the University of Maryland School of Medicines pursuit of more individualized, or personalized, medical treatment.
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University of Maryland Medical Center Launches Genetic-Testing Program for Cardiac Stent Patients