A5070178322- Pharmacogenetics and Drug Metabolism
- Pharmaceutical studies and practices
- Health Systems, Economic Evaluations, Quality of Life
- Pain Management and Opioid Use
- Helicobacter pylori-related gastroenterology studies
- Ethics in Clinical Research
- Colorectal Cancer Treatments and Studies
- Gastroesophageal reflux and treatments
- Neutropenia and Cancer Infections
- Statistical Methods in Clinical Trials
- Health and Medical Research Impacts
- Electronic Health Records Systems
- Biomedical Text Mining and Ontologies
- Antiplatelet Therapy and Cardiovascular Diseases
- Pharmacological Effects and Toxicity Studies
- Opioid Use Disorder Treatment
- Pharmaceutical Practices and Patient Outcomes
- Cancer Treatment and Pharmacology
- Health Sciences Research and Education
- BRCA gene mutations in cancer
- Renal Diseases and Glomerulopathies
- Child and Adolescent Psychosocial and Emotional Development
- Pain Management and Placebo Effect
- Eicosanoids and Hypertension Pharmacology
- Treatment of Major Depression
University of Florida
2018-2025
Florida College
2019-2024
MedStar Health
2024
University of Michigan
2024
University of Colorado Anschutz Medical Campus
2024
Levine Cancer Institute
2024
The increased availability of clinical pharmacogenetic (PGx) guidelines and decreasing costs for genetic testing have slowly led to utilization PGx in practice. Pre-emptive testing, where is performed advance drug prescribing, one means ensure results are available at the time prescribing decisions. However, most efficient effective methods clinically implement this strategy remain unclear.In report, we compare contrast implementation strategies pre-emptive by 15 early-adopter institutions....
Introduction: Pharmacogenetics (PGx) has the potential to improve health outcomes but cost of testing is a barrier for equitable access. Reimbursement by insurance providers may lessen financial burden patients, extent which PGx claims are covered in clinical practice not been well-characterized literature. Methods: A retrospective analysis outpatient submitted payers tests from 1/1/2019 through 12/31/2021 was performed. reimbursement rate calculated and compared across specific test types...
The safety of systemic fluoropyrimidines (e.g., 5-fluorouracil, capecitabine) is impacted by germline genetic variants in DPYD, which encodes the dihydropyrimidine dehydrogenase (DPD) enzyme that functions as rate-limiting step catabolism this drug class. Genetic testing to identify those with DPD deficiency can help mitigate risk severe and life-threatening fluoropyrimidine-induced toxicities. Globally, integration DPYD into patient care has varied greatly, ranging from being required...
In the past decade, pharmacogenomic (PGx) testing to predict drug response have emerged into clinical care. Clinical decision support (CDS) has and continues play a key role in educating prescribers facilitating integration of results routine practice. The Epic Genomics module, an add‐on Epic's base software, allows for storage structured genomic data provides electronic heath record tools designed with PGx CDS implementation mind. early 2022, University Florida Health deployed module. This...
To describe the creation of a curated, shared repository pharmacogenomics cases for pharmacy educators and lessons learned during process. The 2019-2020 American Association Colleges Pharmacy Pharmacogenomics Special Interest Group (PGx SIG) formed an ad-hoc committee charged with creating patient case educational use. Following needs assessment, standardized framework was developed using Pharmacists' Patient Care Process. A guidance document also created authors. maintenance involvement...
There have been significant advancements in precision medicine and approaches to medication selection based on pharmacogenetic results. With the availability of direct‐to‐consumer genetic testing growing awareness interindividual variability, patient demand for more precise, individually tailored drug regimens is increasing. The University Florida (UF) Health Precision Medicine Program (PMP) was established 2011 improve integration genomic data into clinical practice. In ensuing years, UF...
To describe the implementation of CYP2C19 testing into clinical practice at University Florida (UF) Health Gainesville hospital to guide proton pump inhibitor (PPI) dosing and lessons learned from this experience.Different genotypes are associated with variability in PPI plasma concentrations intragastric pH, which may contribute risk treatment failure due subtherapeutic adverse effects (eg, infection, bone fracture, renal dysfunction) sustained supratherapeutic concentrations. Based on...
Opioid prescribing for postoperative pain management is challenging because of inter-patient variability in opioid response and concern about addiction. Tramadol, hydrocodone, codeine depend on the cytochrome P450 2D6 (CYP2D6) enzyme formation highly potent metabolites. Individuals with reduced or absent CYP2D6 activity (i.e., intermediate metabolizers [IMs] poor [PMs], respectively) have lower concentrations metabolites potentially inadequate control. The primary objective this prospective,...
Abstract The efficacy of proton pump inhibitor (PPI) medications is highly dependent on plasma concentrations, which varies considerably due to cytochrome P450 ( CYP2C19 ) genetic variation. We conducted a pragmatic, pilot study genotype‐guided pediatric dosing PPI medications. Children aged 5–17 years old with gastric‐acid‐related conditions were randomized receive either conventional or for total 12 weeks. Sixty children (30 in each arm) enrolled and had comparable baseline...
Introduction: Pharmacogenetic testing may hold promise in addressing health disparities, as medically underserved patients appear to be prescribed medications with pharmacogenetic guidelines at higher rates. While routine clinical implementation of populations has not yet been achieved, using patient perspectives inform should increase the likelihood success. The aim this study was assess perceptions, knowledge, and attitudes regarding patients. Methods: We developed a survey instrument...
The University of Florida Health conducted a pragmatic implementation pharmacogenetics (PGx) panel-based test to guide medications used for supportive care prescribed patients undergoing chemotherapy. was in the context clinical trial with non-hematologic cancers being treated Patients were randomized either intervention arm or control and received PGx testing immediately at end study, respectively. completed MD Anderson Symptom Inventory (MDASI) assess quality life (QoL). A total 150...
Abstract Chronic pain is a prevalent condition with enormous economic burden. Opioids such as tramadol, codeine, and hydrocodone are commonly used to treat chronic pain; these drugs activated more potent opioid receptor agonists by the hepatic CYP2D6 enzyme. Results from clinical studies mechanistic understandings suggest that CYP2D6‐guided therapy will improve control reduce adverse drug events. However, rarely in practice due part demand for additional trial evidence. Thus, we designed...
Pharmacogenetic (PGx) testing is a tool to identify patients at higher risk of adverse events or treatment failure. The concern for unwanted side effects can limit medication adherence, particularly in children and adolescents. We conducted pragmatic study evaluate the acceptability feasibility gather pilot data on utility PGx child adolescent psychiatry clinic. Both physicians families participated answered pre-survey post-survey questionnaires examine their attitudes toward testing....
The vast majority of patients possess one or more pharmacogenetic variants that can influence optimal medication use. When data are used to guide drug choice and dosing, evidence points improved disease outcomes, fewer adverse effects, lower healthcare spending. Although its science is well established, clinical use therapy still in infancy. Pharmacogenetics essentially involves the intersection an individual's genetic with their medications, which makes pharmacists uniquely qualified...
Introduction: This manuscript reports on a pilot program focused implementing pharmacogenetic testing within the framework of an employer-sponsored medical plan at University Florida (UF) Health. The aim was to understand challenges associated with implementation and gather insights into patient attitudes towards PGx testing. Methods: adopted partially preemptive approach, targeting patients current prescriptions for medications relevant gene-drug associations. Patients were contacted via...
The objective of this study was to characterize clinician response following standardization pharmacogenetic (PGx) clinical decision support alerts at University Florida (UF) Health. A retrospective analysis all PGx that fired a tertiary academic medical center from August 2020 through May 2022 performed. Alert acceptance rate calculated and compared across six gene–drug pairs, patient care setting, specialty. disposition the triggering medication with alert evaluated for congruence. There...
Hydrocodone, tramadol, codeine, and oxycodone are commonly prescribed opioids that rely on activation by cytochrome P450 2D6 (CYP2D6). CYP2D6 inhibitors can significantly decrease activity, leading to reduced generation of active metabolites, impairing pain control. To understand this impact, we assessed emergency department (ED) visits in patients initiating these CYP2D6-dependent while CYP2D6-inhibitor antidepressants vs. do not inhibit CYP2D6. This retrospective cohort study included...
Abstract Specific selective serotonin reuptake inhibitors (SSRIs) metabolism is strongly influenced by two pharmacogenes, CYP2D6 and CYP2C19 . However, the effectiveness of prospectively using pharmacogenetic variants to select or dose SSRIs for depression uncertain in routine clinical practice. The objective this prospective, multicenter, pragmatic randomized controlled trial determine genotype‐guided selection dosing antidepressants on control participants who are 8 years older with ≥3...
Pharmacogenetics promises to optimize treatment-related outcomes by informing optimal drug selection and dosing based on an individual’s genotype in conjunction with other important clinical factors. Despite significant evidence of genetic associations response, pharmacogenetic testing has not been widely implemented into practice. Among the barriers broad implementation are limited guidance for how successfully integrate workflows data The Pharmacogenomics Global Research Network...