We know not every child’s body responds the same way to the same dose of the same drug. Most children will respond similarly to the standard dose of a medication, but some children will have side effects and some children will not respond at all.
Pharmacogenomics, the study of how genes affect a person’s response to drugs, is a relatively new field that combines pharmacology and genomics to prescribe effective, safe medications and doses that are tailored to a person’s genetic makeup.
The pharmacogenomics program at Children’s Minnesota is the only pediatric-focused program in the Upper Midwest and one of only a few pharmacogenomics programs in the country focused exclusively on children and adolescents. Two of the conditions most commonly referred to our pharmacogenomics program are cancer and mental health.
In cases of mental health, many drugs take four to six weeks to show efficacy of a new medication. “Kids experiencing depression or other mental health concerns can’t wait over a month to find out whether their medication will control their condition,” said Dr. David Gregornik, PharmD and head of the pharmacogenomics program at Children’s Minnesota. “In many cases, we’re able to reduce the burden of trial and error through data-driven predictions.”
Precision medicine for kids
Pharmacogenomics is part of precision or personalized medicine, which takes into account a person’s genes, environment and lifestyle. The pharmacogenomics program at Children’s Minnesota utilizes molecular testing to analyze genes in order to understand how a patient will metabolize medications. Test results are reviewed by the team and used to select medications and adjust dosages to maximize efficacy from a drug while minimizing side effects and reducing the number of medication trials.
Genetic testing is considered along with other factors including patient age, weight, sex assigned at birth, disease process, use of other medications, health behaviors and environment. Because the genes that impact drug metabolism do not change with age, the test results can be used for both current concerns and future conditions.
The pharmacogenomics program at Children’s Minnesota has an entire team to detect genetic differences and create a therapeutics plan that is safe and effective for every child’s unique body.
Expanding pharmacogenomics at Children’s Minnesota and beyond
The pharmacogenomics program at Children’s Minnesota is focused on expanding the value and benefits of pharmacogenomic testing to more children and teenagers treated at Children’s Minnesota as well as outside of our system.
Dr. Gregornik completed a specialty residency in 1995 in Pediatric Pharmacotherapy at St. Jude Children’s Research Hospital in Memphis, Tennessee, a pioneer in the field of pharmacogenomics. He continued on at St. Jude for 18 years where he provided advanced clinical pharmacy care to children with cancer and undergoing bone marrow transplants. In 2016, he joined Children’s Minnesota and established the pharmacogenomics program.
“For many years, I’ve worked with pediatric cancer patients undergoing chemotherapy, helping to adjust medication doses to ensure therapeutic concentrations while minimizing their risk for toxicity,” said Dr. Gregornik. “By partnering with oncologists, I’m able to support patients in getting the right medication and dosing for optimal benefit while minimizing side effects.”
Dr. Gregornik continues to expand the program through advocating for testing with health insurance providers and the Minnesota state legislature, conducting research to help find new information that will maximize drug effectiveness and minimize toxicity, education of new pharmacists and participation in several research groups and consortia from around the country.
Who is treated in the pharmacogenomics program?
In addition to patients with cancer and mental health conditions, pharmacogenomics testing can provide information for medications used to treat:
- Acid reflux/GERD
- Heart disease
- Infectious diseases
- Pain
- Seizures
The Children’s Minnesota pharmacogenomics program also offers the following services:
- Genetic testing
- Consultations with clinicians about drug selection and dosing
- Patient/family pharmacogenomics education along with evaluation for testing
- Patient results return focused on priority medications and individualized to the patient’s current medical needs
- Education to professional staff and presentations to local clinics
Test results benefit patients in the future
Genetic testing can provide important insights as a child grows, so the pharmacogenomics team has ensured that results will follow a patient through their Children’s Minnesota electronic medical record (EMR). Special programming was developed to trigger an alert when a medication that may need special consideration is added to a patient’s Cerner EMR record. This means any child with pharmacogenomic testing posted in the EMR will benefit from their results, even if the provider did not order the test or was not aware of the results.
“Eventually, as our medical records begin to share more and more information, the benefit of our programming will ensure that a patient who has invested in genetic testing will benefit from it throughout their lifetime,” said Dr. Gregornik.
Refer patients to the Children’s Minnesota pharmacogenomics program
Children and adolescents may be referred by their primary pediatrician or other specialist to make an appointment in the Children’s Minnesota Pharmacogenomics Clinic.
“Our work complements the referring clinician’s care plan. We work closely together to ensure that prescribed medications are efficient, effective and don’t cause undue side effects,” said Dr. Gregornik.
Once a patient has been referred to our program, the next steps include:
- Step 1: In the first appointment, our team will capture a child’s complete medical history and talk through current experiences with medications. If pharmacogenomics testing sounds like the best plan of action, our team will order the appropriate test.
- Step 2: In the second appointment, the team will review the test results with a focus on current medication concerns. The test results help us understand the patient’s gene make up and how their body will break down medications. Along with the test results, our team of specialists will take into account the patient’s age, weight, other medications they’re taking, health behaviors and environment to make our recommendations.
- Step 3: The pharmacogenomics team will use the results of the test and work with the child’s health care provider(s) to adjust medications and dosages in order to improve their effectiveness and minimize side effects.
Please note: Having pharmacogenomic test results prior to prescribing certain medications is key to data-driven selection and dosing decisions and, in many cases, isn’t covered by insurance. The pharmacogenomics team at Children’s Minnesota recognizes the need to reduce out-of-pocket costs and testing turnaround time and is working on options to improve both for patient families.
For a consult or patient referral, please call the Children’s Minnesota Physician Access at 866-755-2121.
Alexandra Rothstein