Transcript Behavioral Health - PGXL Laboratories

PGXL Panels August 2013
Kristen K. Reynolds, PhD
VP Laboratory Operations
Copyright 2012-2013PGXL Laboratories, Louisville KY
All materials herein are the exclusive property of PGXL Laboratories
Physician information
on top
Single gene orders and
ABN annotation
Single req form for all
medical specialties
Panels revised based
on ABN and common
orders
Key Service Lines
Pain Management
– opioid resistance and opioid toxicity
Behavioral Health
– Drug selection to manage treatment resistant depression and psychosis
– Dosing information to minimize adverse drug reactions
Anti-platelet therapy
– Clopidogrel resistance and increased bleeding risk
Thrombotic risk assessment
Statin therapy (ABN)
– Minimum effective statin dose and myopathy risk
Anti-coagulant therapy (ABN)
– warfarin dose estimation and optimal INR interpretation guidance
Single Genes
2D6
2C19
MTHFR
FII
FV
All genes orderable individually
*requires ABN
3A4*
3A5*
1A2*
2C9*
VKORC1*
OPRM1*
SLC6A4*
SULT4A1*
SLCO1B1*
Pain Management
Pain Management
Opioid Sensitivity
2D6
Add OPRM1*
Add SLC6A4*
*requires ABN
Comprehensive Pain
2D6, 2C19, 2C9*, OPRM1*
Add SLC6A4*
Applications in Pain
Opioid prodrug efficacy/ADR: 2D6
Active opioid dose: OPRM1*
NSAID ADR: 2C9*
Other opioids and muscle relaxers: 2C19, 3A4*/3A5*, 1A2*
Methadone: 2C19 (active portion)
Cardiology
Cardiovascular Health
Warfarin
2C9*, VKORC1*
Comprehensive CV Panel
2D6, 2C19, 2C9*, VKORC1*
Clopidogrel
2C19
Thrombophilia Panel
FII, FV, MTHFR
Arrhythmia/Hypertension
2D6
*requires ABN
CV panels have no statin tests?
• All current statin tests require ABN
3A4, 3A5, 2C9, SLCO1B1
• All orderable as single genes at the top of the
req form
Clopidogrel guidelines update 2013
Deepening the evidence base
• Updated literature review
• New section on CYP2C19 sequencing and novel variants. This includes the novel *4B
misclassification issue PGXL addresses in our recent abstract accepted to AMP 2013.
• New section on novel candidate genes.
• New section on who could be considered for CYP2C19 genotyping. Re-focus
recommendations on patients with acute coronary syndromes undergoing PCI.
• Updated data linking CYP2C19 genotype to phenotype.
• Still no recommendations to increase dose in IMs. Discussion about how doubling
the dose is not always enough in IMs and may need to be higher than 150mg/day,
but no complete data for that yet
Scott et al 2013
Behavioral health
Behavioral Health
Basic Psychiatry Panel
2D6, 2C19
Add SLC6A4*
Add SULT4A1*
Add MTHFR
*requires ABN
STA2R Panel
2D6, 2C19, 2C9*, 3A4*,
3A5*, 1A2*, SULT4A1*,
SLC6A4*, MTHFR
Basic Psychiatry Panel
2D6 and 2C19 account for many of the most common
antidepressants and antipsychotics
Add SLC6A4*
Add SULT4A1*
Add MTHFR
*requires ABN
SSRI sensitivity/resistance
olanzapine efficacy
L-methyl folate supplementation
Suregene Panel = 9 genes, 6 of which require ABN
Available as full panel or single genes
Thank You
[email protected]