pharmacogenomics: using personalized medicine to improve ... · demystifying the medical science...
TRANSCRIPT
10/12/2017
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Pharmacogenomics: Advances in Personalized Medicine to Improve Mental Health & Disability Management
Dr. Tyler Amell
October 18, 2017
Schedule 2 Employers’ Group Conference
Pharmacogenomics: Using Personalized Medicine to Improve Mental Health
Demystifying the medical science
The journey from the laboratory workbench to today’s workplaces
Why you should care Health and productivity, temporary work disability, disability prevention
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Physical Health
Examples:
Neuropathic Pain,
Cardiovascular, Cholesterol
Mental Health
Examples:
Anxiety,
Depression
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3 Most Important Takeaways for You
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1Disability
Prevention
2Early Intervention
3 Recovery &
Reintegration
Presenteeism? Stay at Work? Absenteeism?
Pharmacogenomic Impact
What’s in a Word?
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Pharmacogenetics Pharmacokinetics
Pharmacogenomics
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Chemistry and Biology Basics
Human Genome Project
Genetic Variance in
Drug Metabolism
Quicker Return to Function
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Personalized Medicine
Precision Medicine
Personalized Healthcare
Safer – Less Adverse Events
Improved Outcomes
Improved Compliance
Quicker Return to Function
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DNA
Like your fingerprint,
your liver and the enzymes
it contains is unique to you…
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One Size Does Not
Necessarily Fit All…
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Healthcare
services are not
personalized
Evidence-
Informed
Practice
(Evidence-Based
Practice)
Based upon
research
conducted
without genetic
data
Why is this Important for You?
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55%
EM:Extensive or
Normal
Metabolizer
5%
UM:Ultrarapid
Metabolizer
30%
IM:Intermediate
Metabolizer
10%
PM:Poor Metabolizer
*CYP2D6 Enzyme – Involved in 20% of all drug metabolism, not just SSRIs
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Mental Health – Pharmaceutical Interventions
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BENZODIAZEPINES (Xanax, Valium, Ativan)
BETA BLOCKERS
TRICYCLIC ANTIDEPRESSANTS (Amitriptyline, Tofranil,
Norpramin)
MONOAMINE OXIDASE INHIBITORS (MAOIs) (Nardil, Parnate)
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
(SSRIs) (Prozac, Zoloft, Paxil, Celexa)
SEROTONIN-NOREPINEPHRINE REUPTAKE
INHIBITORS (SNRIs) (Effexor)
ANTICONVULSANTS (Lyrica, Neurontin)
TRICYCLIC ANTIDEPRESSANTS (Amitriptyline , Tofranil,
Norpramin)
MONOAMINE OXIDASE INHIBITORS (MAOIs) (Nardil, Parnate)
SELECTIVE SEROTONIN REUPTAKE INHIBITORS
(SSRIs) (Prozac, Zoloft, Paxil, Celexa)
SEROTONIN-NOREPINEPHRINE REUPTAKE
INHIBITORS (SNRIs) (Effexor)
Anxiety Depression
Drug Analytics – A Cautionary Tale
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Physical Health
Examples:
Neuropathic Pain,
Cardiovascular, Cholesterol
Mental Health
Examples:
Anxiety,
Depression
BENZODIAZEPINES (Xanax, Valium, Ativan)
BETA BLOCKERS
TRICYCLIC ANTIDEPRESSANTS (Amitriptyline,
Tofranil, Norpramin)
MONOAMINE OXIDASE INHIBITORS
(MAOIs) (Nardil, Parnate)
SELECTIVE SEROTONIN REUPTAKE
INHIBITORS (SSRIs) (Prozac, Zoloft, Paxil, Celexa)
SEROTONIN-NOREPINEPHRINE REUPTAKE
INHIBITORS (SNRIs) (Effexor)
ANTICONVULSANTS (Lyrica, Neurontin)
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Pharmacogenomics: Case Study in Personalized Medicine
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Demographic: 42 year old male
Employment Status: FT, Professional
Employment Notes: Highly engaged, high achiever, no history of absenteeism/disability
Case Notes: Sudden onset of neuropathic pain
Debilitating acute, episodic pain
High degree of chronic pain
Loss of nerve function in impacted areas
No time lost from work, poster-child for presenteeism
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TimeMAY JUL SEP NOV JAN MAR MAY JUL SEP
Gabapentin (Neurontin)
Aventyl 10mg (Nortriptyline)
Pantoprozole
Aventyl 25mg (Nortriptyline)
Almotriptan
MH-NP GI NP ONLY
Diclofenac
Piroxicam
Tecta
Indomethacin
A Pathway to
Relief
These wasted costs,
and time could have
been avoided, with a
much quicker return
to function!
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PharmacogenomicsSample Reportto Attending Physician and Pharmacist
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Pharmacogenomics: How Personalized Medicine Works
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DNA ResultsWorker was suffering from anxiety or depression? MDD? TRD?
What If… Worker was not working during this time?
Absenteeism vs. Presenteeism
What if co-morbidities developed?
What could the medication costs be?
What could the disability costs be?
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Benefits to You
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Plan
Sponsors
Plan
Members
Some Results – 13:1 ROI
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Quicker Return to Function
1/3 Disability Duration7% on Drug Costs
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3 Most Important Takeaways for You
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1Disability
Prevention
2Early Intervention
3 Recovery &
Reintegration
Presenteeism? Stay at Work? Absenteeism?
Pharmacogenomic Impact
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Thank you Dr. Tyler [email protected]