Research Magazine
What if a simple saliva sample could be tested to curate a specialized treatment plan for a patient? Investigators within the Harrison School of Pharmacy are working to develop ways to implement this cutting-edge technology and bring a personalized approach to medication selection and dosing for patients in Alabama.
Utilizing pharmacogenomics, the study of the relationship between the genome and drug response, a program called TigerMeds Personalized Prescriptions has been initiated within the Auburn University Pharmaceutical Care Center, or AUPCC, to bring this technology to more patients in the state.
With an overall goal of improving health outcomes for Alabamians, this program uses a patient’s pharmacogenomic test results to provide personalized recommendations for medication use. Potential benefits of this approach include decreased risk of medication toxicity, identification of the most effective medication within a class and providing individualized dosing for specific medications.
“This program can potentially show how pharmacogenomics can be implemented in community pharmacies in rural communities, bringing these services to those who would not otherwise have access,” said Dr. Richard A. Hansen, dean of the Harrison School of Pharmacy. “Through collaboration with medical providers, we can bring a precision approach to medication use.”
The program is a collaboration between the Harrison School of Pharmacy’s Division of Clinical Affairs and Outreach, Auburn University Human Resources and HudsonAlpha Health Alliance. HudsonAlpha extends support for groups such as academic institutions, health systems, physician networks and self-insured employers to develop customized genomic programs for their patients or employees. Through HudsonAlpha, the pharmacogenomic testing is supported by $1 million in funding from the Alabama Department of Economic and Community Affairs, or ADECA.
In the TigerMeds Personalized Prescription program, Auburn University employees and covered dependents are eligible for screening if they are taking a medication with a potentially actionable pharmacogenomic intervention based on current consensus guidelines. Pharmacists in the AUPCC provide access to the pharmacogenomic testing in addition to a personalized prescription consult and medication therapy management service.
By conducting the program within the school of pharmacy, faculty have the opportunity to evaluate the clinical and economic outcomes of an outpatient, pharmacist-directed pharmacogenomics clinical service. These outcomes data and incorporation of student pharmacists are missing pieces to widespread implementation.
“This is an exciting new field of science, and we are pleased to introduce this clinical program on campus,” said Dr. Kimberly Braxton Lloyd, associate dean for clinical affairs and outreach in the Harrison School of Pharmacy. “This innovative service not only enhances the health care benefit that we offer to our employees but also allows us to provide pharmacogenomics training for health care students. This prepares our students to integrate this science into the care of their patients upon graduation.”
This program can potentially show how pharmacogenomics can be implemented in community pharmacies in rural communities, bringing these services to those who would not otherwise have access. Through collaboration with medical providers, we can bring a precision approach to medication use.
– Dr. Richard A. Hansen, dean of the Harrison School of Pharmacy
For patients to participate in the program, saliva is easily collected, either in the clinic or via an at-home collection kit. Patients can elect to be seen in-person in the AUPCC or via HIPAA-compliant telehealth.
Patients receive a minimum of two appointments, including an initial educational appointment and a follow-up appointment to discuss the patient-specific pharmacogenomic results. If actionable results are identified, medication therapy changes are coordinated with the patient’s health care team.
“As a profession, we have long recognized that individuals respond differently to medications. With the availability of programs like this that use next generation sequencing, patient-specific pharmacogenomic data are more readily accessible than ever before,” Hansen said.
In preparation for program launch, the Harrison School of Pharmacy hired Courtney Watts Alexander, Pharm.D., as assistant professor of clinical pharmacogenomics. A 2013 Harrison School of Pharmacy graduate, she completed residency programs at the University of Texas MD Anderson Cancer Center and at St. Jude Children’s Research Hospital, where she first encountered pharmacogenomics in her oncology practice.
“Pharmacogenomics is becoming more common within all areas of pharmacy practice,” Alexander said. “Within the oncology setting, the desire to target specific pharmacogenomic markers on tumor cells to optimize cure rates and minimize toxicity from nonspecific chemotherapy agents is driving the development of targeted therapies.
“Pharmacogenomic screening is also being implemented due to the recognition that some patients may experience reduced efficacy or increased toxicity with certain medications. We are moving away from a ‘one size fits all’ prescribing model.”
Also housed within the Harrison School of Pharmacy is the Center for Pharmacogenomics and Single-Cell Omics Initiative, or AUPharmGx. Having it, along with programs like the TigerMeds Personalized Prescriptions Program, allows for collaborative opportunities to bring bench research and clinical practice together.
“The overall goal of AUPharmGx is to facilitate generation of data in support of advancing precision medicine, making projects like the TigerMeds Personalized Prescription program an ideal integration and collaboration within the school of pharmacy,” said Dr. Tim Moore, associate dean for research programs in the Harrison School of Pharmacy.
With Alexander on board, the team is applying the technology to other projects, illustrating the potential impact of clinical pharmacogenomics and the link between clinical and translational research.
Partnering with the United States Department of Veterans Affairs and its Tuscaloosa medical center, Alexander is leading a team that is assessing the impact of clinical pharmacogenomics on real and potential medication use in veterans. This project applies the same clinical approach to a different population of patients. The project is also using the AUPCC’s telehealth infrastructure to provide virtual pharmacogenomics consultations with the patients.
Supported by a pilot grant from the University of Alabama at Birmingham, or UAB, Center for Clinical and Translational Science, the Harrison School of Pharmacy team will conduct a pilot study to determine the rate of pharmacogenomic variation with actionable recommendations for mental health medications utilized to treat major depressive disorder among veterans and assess the impact of pharmacogenomic analysis on medication utilization, costs, safety, efficacy and adherence.
Alexander and Braxton Lloyd also received funding from the Alabama Pharmacy Association Research and Education Foundation to conduct a feasibility study on the use of preemptive pharmacogenomics to predict a patient’s response to opioid analgesics and non-steroidal anti-inflammatory drugs.
In this study, pharmacogenomics is used to identify how a patient metabolizes pain medications, which aides in medication selection. This could allow clinicians to understand why some patients require dose escalation for pain control, which is often a concern for health care providers, especially with the current opioid epidemic in the United States.
By utilizing pharmacogenomics to study response to opioids, the door further opens for collaboration within the school of pharmacy with the newly-created Center for Opioid Research, Education and Outreach. Bringing together these interdisciplinary approaches to improve health outcomes further advances the overall mission of the Harrison School of Pharmacy.
“These programs are great examples of the advantage of having the AUPCC within the Harrison School of Pharmacy,” Hansen said. “Along with being a practice and training site for our students, it also allows us to explore these innovative and new technologies, identifying ways to work them into a practice model.”