Inter-individual responses to drug intake are frequently observed and may be caused by multiple factors, including disease modalities, drug-drug interactions, drug-food interactions and notably genetics. Pharmacogenetics (PGx) has been defined as the study of variability in drug response due to heredity. The aim of pharmacogenetics is to identify, through genetic testing, those patients, who will benefit from a particular drug (response) or those who, due to their genetic background, carry a predictable risk of non-response or adverse drug reaction. In the last three decades, there has been an extensive evolution of the knowledge on the genetic factors influencing drug metabolism, transport and effect. As a result, pharmaceutical companies increasingly cite the known influence of genetic variants on serum levels, adverse drug reactions and treatment failure in their drug labels. Furthermore, a number of guidelines for pharmacogenetic guided drug selection and dosing are available today. However, pharmacogenetic testing is not yet part of routine patient care.
We hypothesize that alongside with accepted factors like drug-drug interactions and disease modalities, there is enough evidence to beneficially incorporate pharmacogenetic information into pharmaceutical care practice. To assess the applicability of pharmacogenetic services in community and hospital pharmacies, we conduct a case series and clinical study. Furthermore, we aim to develop a post-graduate educational program on pharmacogenetics for health care professionals.
Current PhD Projects
Implementation of Pharmacogenotyping in Pharmaceutical Care (Chiara Jeiziner since AUG 2018)
Health care professionals need harmonization and standardization of pharmacogenetic information in drug labels to personalize drug therapies and tailor pharmaceutical care. A systematic analysis of the Swiss drug labels revealed that drug labels of 93 substances contain relevant pharmacogenetic information that were classified as “actionable PGx”. We collect patient cases in community pharmacies, where pharmacogenotyping is applied. The primary endpoint is that the patient receives the results of the pharmacogenotyping in form of a written recommendation to their prescribing physician. The experience with the compiled cases will be basis for the development of a reliable standard operating procedure for pharmacogenetic testing in pharmaceutical care. [ClinicalTrials.gov identifier: NCT04154553; EKNZ Identifier: 2019-01452]. The enrichment of a medication review with a pharmacogenetic profile for patients with adverse drug reactions or treatment failure can be of important value. At last, the communication of complex information such as pharmacogenetics to the patient as well as to the physician are challenges yet to overcome.
Pharmacist guided pharmacogenotyping in psychiatric practice (Céline Stäuble since DEC 2018)
Despite the compiling evidence on pharmacogenetics influencing antidepressant exposure as well as response, pharmacogenetic guided antidepressant treatment has not yet made its way into routine psychiatric practice. Underlying reasons are diverse and include financial and procedural aspects as well as the limited transfer of knowledge into basic trainings, but also a lack of prospective clinical trials. In this project, we investigate genetic variants in cases of adverse drug reactions and treatment failure [ClinicalTrials.gov identifier: NCT04154553; EKNZ ID: 2019-01452] and further the impact of pharmacogenetic guided antidepressant selection and dosing on treatment outcome in a clinical study [ClinicalTrials.gov identifier: NCT04507555; EKNZ ID: 2020-01535].