New Program Aids Physicians Identify Gene-Drug Interactions

A data management and analysis platform gives doctors real-time therapeutic and diagnostic guidance, based on the patient’s genetic profile.

Developed by researchers at Mount Sinai Medical Center (MSMC; New York, NY, USA), the revolutionary platform communicates with the MSMC electronic health record (EHR). MSMC is pilot testing the platform through the CLinical Implementation of Personalized Medicine through Electronic health Records and Genomics (CLIPMERGE) research program. Once a patient has consented to take part in CLIPMERGE, their DNA is analyzed for genetic variations, which are stored on the platform, and remain there until the patient is prescribed a medication for which CLIPMERGE holds genomically relevant information.

Such information could include a lower likelihood of the drug being effective, or there being a higher chance of side effects due to that patient’s particular type of genetic variation. When this happens, CLIPMERGE displays an alert on the EHR screen and sends a message, in real time, to the attending physician, consisting of text describing the reason for the alert, some suggestions of alternative medications or doses that could be used, and a link to reference material so that physicians can read more about the science and evidence for pharmacogenomics. A study describing CLIPMERGE will be published in the August 2013 issue of Clinical Pharmacology and Therapeutics.

“Our knowledge of pharmacogenomics, or genome-drug interactions, and how genetics can influence why some patients react better to some drugs than others, is growing rapidly, and will likely transform how drugs are prescribed in the future,” said lead author Omri Gottesman, MD. “We hope that through CLIPMERGE, we can establish best practices both technological and human; and a robust process for clinical-decision support to deliver relevant genomic information to physicians at the moment they are caring for patients.”

Beyond the 1,500 patients enrolled in the pilot project, Mount Sinai has also enrolled since 2007 a total of 25,000 patients in the BioMe Biobank, one of the largest genetic repositories in the United States. The combination of BioMe and CLIPMERGE allows feedback on optimal therapeutics for multiple conditions related to cardiovascular disease, blood clots, high cholesterol, depression, and pain, based on a patient’s DNA, and is an important step forward on the road to personalized medicine.

“Enrolling this number of patients is a significant achievement for Mount Sinai and combined with programs such as CLIPMERGE, is propelling us to the forefront of precision medicine and its application in the clinical setting,” said Dennis Charney, MD, executive vice president for academic affairs of The MSMC. “The future of medicine lies in genomics research and translating it to the bedside—and Mount Sinai’s commitment to translational research makes us uniquely poised to lead that revolution.”

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