Youngwoo Cho, Sami Elahi, Matthew M. Jack, John Campbell, Emily Smith, Randall W. Knoebel, David George, Larry House, Kiang-Teck J. Yeo, Theodore Karrison, Samuel L. Volchenboum, David O. Meltzer, Russell Z. Szmulewitz, Everett E. Vokes, Mark J. Ratain, Peter H. O'Donnell
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引用次数: 0
摘要
生殖系药物遗传学(PGx)越来越多地用于定制药物选择/剂量。然而,现有系统主要将PGx结果传达给提供者,限制了患者的直接参与。为了解决这个问题,我们开发了YourPGx Oncology,这是一个面向患者的创新门户网站,通过33个独特的患者友好摘要提供多基因PGx结果(CYP2D6, UGT1A1, DPYD)。该工具的效用在肿瘤人群中进行了前瞻性评估,这些药物基因影响高风险治疗。参加PhOCus研究(NCT04541381)的患者亲自或通过视频会议参与了对该工具的单次评估,药剂师可以提供问题,并管理评估教育影响的前后调查。每位患者查看自己先前获得的PGx结果。在190名符合条件的患者中,70名通过电子邮件、电话和面对面的方式回应了请求,其中51名(73%)完成了观察疗程并完成了调查。患者浏览YourPGx Oncology的平均时间为13.4分钟(8.1-21.0分钟)。门静脉交互后,患者对化疗和止痛药的个体疗效和安全性估计的识别能力显著提高,准确识别pgx告知的药物疗效可能性的比例从32%上升到72%(从不一致到一致的疗效知识的比值比[OR] = 5.8, P
Impact of First-of-Its-Kind Patient-Facing Pharmacogenetics Tool on Dosing Decisions and Treatment Outcomes
Germline pharmacogenetics (PGx) is increasingly used to tailor medication selection/dosing. However, existing systems primarily communicate PGx results to providers, limiting direct patient engagement. To address this, we developed YourPGx Oncology, an innovative patient-facing portal that delivers multi-gene PGx results (CYP2D6, UGT1A1, DPYD) through 33 unique, patient-friendly summaries. The utility of this tool was prospectively evaluated in an oncology population, where these pharmacogenes impact high-stakes treatments. Patients enrolled in the PhOCus study (NCT04541381) participated in single-session evaluations of the tool in-person or via videoconference, with a pharmacist available for questions and administering pre- and post-surveys that assessed educational impact. Each patient viewed their own previously obtained PGx results. Of 190 eligible patients, 70 responded to solicitations via email, phone, and in-person, of whom 51 (73%) completed an observed session and completed surveys. Patients spent a median of 13.4 minutes (range 8.1–21.0) navigating YourPGx Oncology. After portal interaction, patients' ability to identify individual efficacy and safety estimates for chemotherapies and pain medications significantly improved, with the proportion accurately recognizing PGx-informed drug efficacy likelihoods rising from 32% to 72% (Odds Ratio [OR] = 5.8 for the shift from discordant to concordant efficacy knowledge, P < 0.001), and PGx-related toxicity recognition increasing from 31% to 57% (OR = 3.2, P = 0.01). Our findings show that a customized patient-facing PGx results portal enhances patient understanding of individual medication efficacy and toxicity likelihoods, highlighting the potential key role of direct-to-patient PGx tools to facilitate optimized treatment-informed care and promote genetically guided shared decision-making.
期刊介绍:
Clinical Pharmacology & Therapeutics (CPT) is the authoritative cross-disciplinary journal in experimental and clinical medicine devoted to publishing advances in the nature, action, efficacy, and evaluation of therapeutics. CPT welcomes original Articles in the emerging areas of translational, predictive and personalized medicine; new therapeutic modalities including gene and cell therapies; pharmacogenomics, proteomics and metabolomics; bioinformation and applied systems biology complementing areas of pharmacokinetics and pharmacodynamics, human investigation and clinical trials, pharmacovigilence, pharmacoepidemiology, pharmacometrics, and population pharmacology.