Personalized therapeutics clinic investigates complex medication issues, recommends alternatives
December 13, 2017
When two people take the same medicine at the same dose, the results are rarely identical. But when multiple prescriptions are on the table, puzzling side effects can surface along with complex medical problems stemming from frustrating trial-and-error dosing regimens.
The need for personalized care continues as individual differences to drugs become increasingly common. In recent years, doctors have taken new approaches to address these issues by incorporating individualized, precision medicine tactics to improve treatments.
The Personalized Therapeutics Clinic (PTC), in its inaugural year, takes a precision medicine approach to patient care with one overarching purpose: to provide input from a clinical pharmacologist (a physician) and a staff pharmacist regarding complex medication issues.
Manish Sharma, MD, assistant professor of medicine and attending physician of the PTC played an integral role in developing the new clinic.
“The PTC’s attending physicians are all trained in clinical pharmacology, either board certified or board eligible, and this is one of the only ambulatory clinics where a staff pharmacist is available in person,” said Sharma.
The PTC consists of several collaborating units, including the Center for Personalized Therapeutics, the Committee on Clinical Pharmacology and Pharmacogenomics, and the UChicago Medicine Pharmacy. Working collectively, these units help provide unique and comprehensive treatment recommendations for patients.Patients can have a difficult time keeping track of their medicine, which compromises treatment outcomes
“In addition to providing individualized patient care, we have rotating trainees who work on each case alongside the physicians and pharmacists," said Sharma. “This creates a unique educational opportunity for clinical pharmacology fellows and pharmacy residents.”
Mark Ratain, MD, the Leon O. Jacobson Professor of Medicine and one of PTC’s seven attending physicians, has helped spearhead similar initiatives at UChicago geared toward personalized medicine and other tailored treatment strategies.
“This clinic really focuses on the individual and helps uncover the processes behind drug metabolism,” said Ratain. “Our clinical pharmacologists and pharmacists are here to find and recommend viable treatment alternatives to mitigate risk for drug toxicity.”
Patient referrals are made by UChicago physicians or pharmacists. Case topics can include:
- Pharmacogenomics: When variations in a patient’s genes significantly affect the response to medications
- Polypharmacy: When complications arise when more than one drug is used to treat an illness, or when patient adherence or compliance to medications becomes problematic
- Drug-drug interactions: The presence of one drug interacts with another, hindering therapy or causing new, unwanted symptoms
- Dosing in the context of organ dysfunction: Adjusting the dose of medication considering dysfunctional organs (liver or kidneys) that affect drug metabolism
- Therapeutic drug monitoring: Measuring actual drug concentrations in the blood
For example, a patient who we will call Jane was referred to PTC for polypharmacy issues because her number of outpatient medications totaled 36. The requesting service asked for recommendations to safely consolidate her medications and inquired about possible pharmacogenomic factors that could affect how she metabolizes her medicine.
The PTC noted some of Jane’s medications were metabolized via similar mechanisms, and it was recommended that she be screened for a couple key genes to determine if she is predisposed to metabolize her medications poorly. The test results could help guide her future treatment.
Sandeep Parsad, PharmD, BCOP, assistant director of pharmacy for UChicago’s cancer and investigational drug services, helped with Jane’s case.
“Patients can have a difficult time keeping track of their medicine, which compromises treatment outcomes," said Parsad. "We help refine medication lists, evaluate for drug interactions or therapeutic duplications that cause side effects, and then educate the patient on these issues.”
Sometimes knowing when not to take medical action can be equally valuable. This was the case for a patient we will call Sharon. Her blood frequently oscillates between too thick and too thin, and her doctors suspected that her inconsistent response to her medication was genetically-driven, so they consulted the PTC.
After speaking with Sharon and cross-referencing her case with the scientific literature, the PTC concluded that the costs of pharmacogenetic tests would likely outweigh the benefits. There was insufficient evidence to suggest that ordering the tests would significantly improve her care and management. The PTC gave their recommendations to Sharon’s care team accordingly.
Ultimately, the PTC hopes to provide a valuable service for primary care physicians who need guidance on complex medication issues for their patients with a variety of underlying diseases. The clinic operates Friday mornings, 8:30am–11:30am in the Duchossois Center for Advanced Medicine.