copyright 2012-2013pgxl laboratories, louisville ky all materials herein are the exclusive property...
TRANSCRIPT
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Copyright 2012-2013PGXL Laboratories, Louisville KYAll materials herein are the exclusive property of PGXL Laboratories
PGXL Panels August 2013
Kristen K. Reynolds, PhDVP Laboratory Operations
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Single gene orders and ABN annotation
Single req form for all medical specialties
Panels revised based on ABN and common orders
Physician information on top
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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
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Single Genes2D62C19MTHFRFIIFV
3A4*3A5*1A2*2C9*VKORC1*OPRM1*SLC6A4*SULT4A1*SLCO1B1*
All genes orderable individually*requires ABN
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Pain Management
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Pain Management
Opioid Sensitivity2D6
Add OPRM1*Add SLC6A4*
Comprehensive Pain2D6, 2C19, 2C9*, OPRM1*
Add SLC6A4*
*requires ABN
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Opioid prodrug efficacy/ADR: 2D6Active opioid dose: OPRM1*NSAID ADR: 2C9*Other opioids and muscle relaxers: 2C19, 3A4*/3A5*, 1A2*Methadone: 2C19 (active portion)
Applications in Pain
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Cardiology
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Cardiovascular Health
Warfarin2C9*, VKORC1*
Clopidogrel2C19
Arrhythmia/Hypertension2D6
Comprehensive CV Panel2D6, 2C19, 2C9*, VKORC1*
Thrombophilia PanelFII, FV, MTHFR
*requires ABN
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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
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Clopidogrel guidelines update 2013Deepening 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
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Behavioral health
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Behavioral Health
Basic Psychiatry Panel2D6, 2C19
Add SLC6A4*Add SULT4A1*Add MTHFR
STA2R Panel2D6, 2C19, 2C9*, 3A4*, 3A5*, 1A2*, SULT4A1*, SLC6A4*, MTHFR
*requires ABN
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Basic Psychiatry Panel
2D6 and 2C19 account for many of the most common antidepressants and antipsychotics
Add SLC6A4* SSRI sensitivity/resistanceAdd SULT4A1* olanzapine efficacyAdd MTHFR L-methyl folate
supplementation
*requires ABN
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Suregene Panel = 9 genes, 6 of which require ABNAvailable as full panel or single genes