Genetics Guided Individualiized Coumadin Dosing

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ottagal

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FYI...
May be of interest:
For media release: https://lawsonresearch.com/archived_releases/2011/pdf/07_18_2011.pdf

http://thehealthline.ca/displayArticle.aspx?id=2397

Tuesday, July 19, 2011
London Health Sciences Centre and Lawson Health Research Institute
Made to Measure Medicine Already Benefitting Patients


London, ON - A cutting-edge approach to personalized drug dosing is already showing benefits for patients and is getting attention from a widely-respected international journal. Dr. Richard Kim is a physician at London Health Sciences Centre (LHSC) and scientist at Lawson Health Research Institute. He and his team of researchers use a patient’s genetic profile to give health care providers an individualized dosing approach for the drug warfarin (Coumadin™), a commonly prescribed blood thinner (anticoagulant).

In a peer-reviewed study published in the journal Blood, patients treated at LHSC's Personalized Medicine Clinic using this genetics-guided individualized dosing approach were shown to safely and rapidly attain optimal levels of blood thinning. This study was the first of its kind to incorporate a larger first dose of warfarin - called a "loading" dose - as well as an optimal regular dose, called the "maintenance" dose based on a patient's genetic makeup.

According to Dr. Kim, "Personalized medicine will allow us to tailor drug treatment to each patient’s specific genetic fingerprint. It is showing tremendous potential in helping us treat patients more effectively with warfarin and a number of drugs on the market today. This is an approach we’re hoping to share with hospitals across Ontario and throughout Canada and beyond.”

Dr. Kim and his colleagues adopted this strategy for initiating warfarin therapy to prevent unexpected hemorrhagic events and to ensure all patients receive optimal benefit from warfarin, the most widely prescribed blood thinning drug in Canada, used to treat conditions such as deep vein thrombosis (DVT), pulmonary embolism (PE), and an irregular heart rhythm condition called atrial fibrillation (A. Fib). Unfortunately, due to marked variability in the dosing requirements among patients, it can often take many weeks to attain an optimal level of blood thinning for those who are treated with this drug.

Warfarin is also the number one cause of adverse drug response-related hospitalizations. Since the safe and effective dose for an individual patient is not known, the first months of warfarin treatment present higher risk of over-anticoagulation with hemorrhagic complications.

The Personalized Medicine Clinic opened at LHSC's University Hospital in 2008. The clinic is the first of its type in Canada to adopt a genetics-guided personalized medicine approach as a part of care for patients on warfarin.

The study was made possible through the Drug Innovation Fund of Ontario Ministry of Health and Long-term Care. Access the full text version here.

Media Contact:
 
There's been quite a bit of work on this area recently. However, the cost of the testing seems to have been an issue that may relegate this to publicly funded research projects and organizations. The article speculates on dosing for other drugs, based on certain genetic markers. While this sounds like a great idea -- in addition to cost of the test -- I wonder how many medications can actually use genetic testing to determine the actual suggested starting dose.

This is certainly an interesting area to explore, but I have doubts about genetic testing to be of much value for more than a handful of medications. (It would be nice if a person's genome -- or at least the areas that ARE tested -- can be tested once and stored in a file (maybe on a flash drive on your keychain?) so that you'll always have the data available and avoid unnecessary repeat genetic tests.)
 
Not really. Sure, there may be money to be made, but the goal for the genetic testing for warfarin sensitivity is to speed up the process of getting to the target INR. It can help prevent a person from negative thrombotic events and can help prevent the 'roller coaster' effect from happening. I think there's a real reason for genetic warfarin sensitivity. The only ones who will be making money will be the lab doing the genetic testing and, perhaps, the doctor reviewing the results. There's not really any money to be made from generic warfarin.

Money, in this case, doesn't really seem to be much of an issue.
 

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