copyright 2012-2013pgxl laboratories, louisville ky all materials herein are the exclusive property...
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Copyright 2012-2013PGXL Laboratories, Louisville KYAll materials herein are the exclusive property of PGXL Laboratories
PGXL Panels August 2013
Kristen K. Reynolds, PhDVP Laboratory Operations
Single gene orders and ABN annotation
Single req form for all medical specialties
Panels revised based on ABN and common orders
Physician information on top
Key Service Lines
Pain Management– opioid resistance and opioid toxicity
Behavioral Health– Drug selection to manage treatment resistant depression and psychosis– Dosing information to minimize adverse drug reactions
Anti-platelet therapy– Clopidogrel resistance and increased bleeding risk
Thrombotic risk assessment
Statin therapy (ABN)– Minimum effective statin dose and myopathy risk
Anti-coagulant therapy (ABN)– warfarin dose estimation and optimal INR interpretation guidance
Single Genes2D62C19MTHFRFIIFV
3A4*3A5*1A2*2C9*VKORC1*OPRM1*SLC6A4*SULT4A1*SLCO1B1*
All genes orderable individually*requires ABN
Pain Management
Pain Management
Opioid Sensitivity2D6
Add OPRM1*Add SLC6A4*
Comprehensive Pain2D6, 2C19, 2C9*, OPRM1*
Add SLC6A4*
*requires ABN
Opioid prodrug efficacy/ADR: 2D6Active opioid dose: OPRM1*NSAID ADR: 2C9*Other opioids and muscle relaxers: 2C19, 3A4*/3A5*, 1A2*Methadone: 2C19 (active portion)
Applications in Pain
Cardiology
Cardiovascular Health
Warfarin2C9*, VKORC1*
Clopidogrel2C19
Arrhythmia/Hypertension2D6
Comprehensive CV Panel2D6, 2C19, 2C9*, VKORC1*
Thrombophilia PanelFII, FV, MTHFR
*requires ABN
CV panels have no statin tests?• All current statin tests require ABN
3A4, 3A5, 2C9, SLCO1B1• All orderable as single genes at the top of the
req form
Clopidogrel guidelines update 2013Deepening the evidence base • Updated literature review• New section on CYP2C19 sequencing and novel variants. This includes the novel *4B
misclassification issue PGXL addresses in our recent abstract accepted to AMP 2013.• New section on novel candidate genes.• New section on who could be considered for CYP2C19 genotyping. Re-focus
recommendations on patients with acute coronary syndromes undergoing PCI.• Updated data linking CYP2C19 genotype to phenotype. • Still no recommendations to increase dose in IMs. Discussion about how doubling
the dose is not always enough in IMs and may need to be higher than 150mg/day, but no complete data for that yet
Scott et al 2013
Behavioral health
Behavioral Health
Basic Psychiatry Panel2D6, 2C19
Add SLC6A4*Add SULT4A1*Add MTHFR
STA2R Panel2D6, 2C19, 2C9*, 3A4*, 3A5*, 1A2*, SULT4A1*, SLC6A4*, MTHFR
*requires ABN
Basic Psychiatry Panel
2D6 and 2C19 account for many of the most common antidepressants and antipsychotics
Add SLC6A4* SSRI sensitivity/resistanceAdd SULT4A1* olanzapine efficacyAdd MTHFR L-methyl folate
supplementation
*requires ABN
Suregene Panel = 9 genes, 6 of which require ABNAvailable as full panel or single genes
