By Ernie Hood
“Inherited genetic differences may affect the way your body breaks down this drug. Talk to your doctor about testing.”
Those words, or similar ones, could be coming to a prescription bottle near you, on one of those brightly colored, so-called “auxiliary” labels — stickers designed to give you more information about how or when to take the accompanying pills, or to provide other useful clinical information such as avoiding sunlight or grapefruit.
According to Susanne Haga, Ph.D., of the Duke Center for Applied Genomics and Precision Medicine, auxiliary labels could be one strategy to promote patient awareness of pharmacogenetic testing. “It might be possible to alert patients as they pick up their prescriptions to a particular effect or impact of genetic variation that would stimulate them to seek further information or talk to their pharmacist and/or physician about whether testing might be relevant to them,” Haga explained.
The Future Is Now
As pharmacogenetic tests become more common and enter the mainstream of clinical practice, the need to inform patients about their existence and usefulness is growing.
Boosting patients’ awareness and knowledge would bring a variety of benefits. For example, providing them with additional information about a drug’s side effects and its likelihood to work would give them more confidence in discussing a medication or future medications with their doctor or pharmacist. Increased understanding of and confidence in a drug’s safety and efficacy is likely to increase adherence, always a major issue with prescription regimens.
Auxiliary labeling to promote pharmacogenetic testing has some inherent limitations, in that the drug in question has already been prescribed to the patient, so testing of an individual’s genetic variability profile would take place after the drug is already being taken.
Haga acknowledges that it’s not an ideal solution. Research shows fewer than 50 percent of patients with depression respond to their first medication, so it’s very possible that by the time a person sees this labeling, they’ve already been prescribed an ineffective drug and will soon be heading back to their healthcare provider to try again. But Haga says the labels would still be a step forward in empowering patients to seek more information.
Getting out in front of increasing patient awareness earlier in the process may be vital to the ultimate success of pharmacogenetic testing. Haga sees a number of different steps when that type of education could occur during what she characterizes as a continuum from the patient visit with the provider or physician through to receiving and filling a prescription.
“The provider certainly has a key role in increasing their patients’ awareness of these tests and discussing them with the patients to the best of their ability within the constraints of an office visit,” she said. “There are a number of opportunities; it’s just that given the novelty of the tests, there are still a number of barriers to getting that information across, both to providers and to patients at this time.”
A Pharmacist’s Role
Haga believes that as more primary care physicians become knowledgeable about the benefits of pharmacogenomics and begin to order more tests, pharmacists will become increasingly important liaisons between providers and patients. “They hold the knowledge, as experts in drug metabolism and drug kinetics, and in many instances, they do have a relationship with the patient,” she observed, adding that pharmacists could help educate both the provider and the patient about testing and whether or not the results indicate changes in dosing or drug selection.
Haga noted that it remains to be seen whether pharmacists will embrace that role and add it to the portfolio of services they offer in the retail pharmacy setting. So stay tuned, as pharmacogenetic testing may be next in line at your local pharmacy.