While a lot of the discussion about personalized medicine is focused on the future, Felix Frueh of Medco Health Solutions believes the most promising possibilities for individualized care could be implemented right now.Knowing a person’s underlying genetics with currently available tests could make certain widely prescribed drugs more effective while also avoiding adverse reactions, according to Frueh, who is the president of the Medco Research Institute and spoke to the Spittoon last week.“There are very actionable pieces of information that we can derive from genetic testing,” said Frueh.23andMe is interested in getting this information into the hands of consumers and their doctors. It’s an effort to get away from the “one size fits all” approach to developing and prescribing medication. Pharmacogenomics aims to personalize the use and development of medicine by using a person’s genotype to determine the best drugs for an individual at the best dose. 23andMe’s Drug Response reports provide a glimpse into the potential power of this approach. For different individuals, the same drug could be lifesaving, have no effect, or even be life threatening.
Looking specifically at the drugs warfarin (Coumadin ®), and Clopidogrel (Plavix®), there are underlying genetics that can indicate how a patient will respond to the drugs.This offers great utility for both doctors and patients, according to Frueh. But less than 1 percent of those prescribing such medication are using available genetic testing to screen for drug responses, he said.For Frueh this is an opportunity for a “teachable moment.”
Medco has been involved in several studies looking at both the utility of the tests as well as the willingness of doctors to use them.While there are genetic tests that can help doctors and patients, they are rarely used. This has more to do with a lack of knowledge about the tests than their usefulness.
To that point, Frueh mentioned that in Medco’s clinical programs where physicians who prescribe one of those drugs are contacted by Medco to inform the doctor about the availability of a genetic test that can help guide therapy, about a quarter of the contacted physicians ended up using the tests.“To me this means that the physicians or patients are not unwilling to use [genetic testing] but that they quite literally don’t know about it,” he said. “From a pharmacogenomics perspective [the test] is sort of a no brainer.”Frueh, who works on Medco’s efforts to improve the safety and efficacy of prescription drugs, will touch on some of these same ideas and opportunities early next year at the Personalized Medicine World Conference 2012.Frueh knows the promise of pharmacogenomics having worked previously as the associate director of genomics at the FDA. He helped create the genomics review team for the Center for Drug Evaluation and Research and chaired the first interdisciplinary pharmacogenomics review group.Medco’s work suggests that testing can be helpful not just for doctors but patients as well, especially when it is targeted to a specific treatment. A recent study by the company in collaboration with Quest Diagnostics indicates that patients taking statin drugs to lower cholesterol are more likely to take their medications if they’ve been genetically tested for the KIF6 marker. The variant is associated with better response to statin treatment.“Basically the idea of the study is whether providing information back to patients has an impact on their adherence to statin therapy,” said Frueh.It does have an impact, and a significant one at that, he said. This not only improves outcomes for the patients, but it can save a lot of money in health care costs. The company reported in June that patients who took statins as prescribed reduced their health care costs by $944 over a year and a half and lowered their risk of hospitalization or heart problems.For Frueh this indicates that at least in the case of specifically targeted information related to an on-going treatment, genetic testing can help encourage a patient to change his or her behavior.It also offers a promising opportunity to personalize medicine now, instead of at some time in the future.See Felix Frueh and other leaders in this field at the Personalized Medicine World Conference in early 2012 (see sidebar for details).