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Full NameDr Maria Donovan
School of Pharmacy
University College Cork
- genetics, genomics and molecular biology
- neuroscience and mental health
- artificial intelligence/machine learning/data analytics
- General Practice
- Community Medicine
We are currently undertaking an observational study focusing on patients being treated by psychiatry services with either antipsychotic medicines (for first episode psychosis (FEP)) or antidepressant medicines (for treatment resistant depression (TRD)). Pharmacogenomic testing for specific genes implicated in the action, or the metabolism/clearance of antipsychotics and antidepressants may present an opportunity to personalise the medication regimen of patients with these mental health conditions. For both classes of medicines, a number of patients either will not respond to treatment (15% to antipsychotics in FEP and up to 66% to antidepressants used first-line in the treatment of depression) or will develop side-effects to treatment (10-18% of patients report intolerable side-effects to antipsychotics including the development of metabolic syndrome, and over 50% report bothersome side-effects to antidepressants).
To study the drug-gene effect, genetic material (blood samples and saliva samples from the mouth) will be collected and tested for specific genes. Clinical data will also be recorded to observe the drug-gene effect.
As a follow-on from the pharmacogenetic observational study to identify opportunities to individualise treatment for patients with mental health conditions, a potential research project would be to widen the pharmacogenetic testing out to a wider group of patients through general practice/in the community.
A previous study (PREPARE study) found a statistically significant reduction in clinically relevant adverse drug reactions in patients who had pre-emptive pharmacogenetic testing using a 12 gene panel and pharmacogenetic-guided prescribing versus standard care. Furthermore, it is known that the majority of the population have at least one actionable pharmacogenomic variant (98.1% of 9797 patients in a US study) , meaning that a change to a medicine or a dosage regimen would be required (David SP et al, 2021). In the ICANPIC trial carried out in a community pharmacy setting in Canada, the following drug classes/medicines were the ones triggering reactive pharmacogenetic testing due to lack of efficacy or adverse drug reactions: antidepressants (33.9%), statins (22.1%), clopidogrel (12.6%), proton pump inhibitors (12.6%), opioids (7.9%), warfarin (7.1%) and other (including benzodiazepines, COX-2 inhibitors, beta-blockers and NSAIDs (3.9%). These are all commonly used medicines in acute medical wards and in general practice. The purpose of this study is to develop a service-provider and user friendly process to identify patients to test pharmacogenetic variants in, to identify the impact on potential adverse drug reactions and treatment outcomes and to implement pharmacogenetic-guided prescribing in Ireland.
Prof Laura Sahm
Prof Gerard Clarke