Background: A goal of an Individualized Pediatric Therapeutics (IPT) Clinic is to find the right medication without a trial and error process. Personalizing medicine incorporates knowledge related to medication therapy (pharmacokinetics, formulation options, pharmacology) with several laboratory technologies to individualize medicine. The IPT Clinic at Children’s Mercy was established in 2010 as part of our initiative to integrate the advancements of genomic technologies into patient care. We utilize a multidisciplinary team approach to solve clinically significant medication-related problems. Our team includes physicians, pharmacists, clinical pharmacologists, basic scientists, and nurses. We meet one week prior to the clinic visit to review a patient’s medical history. On the day of the clinic visit, a physician and pharmacist meet with the patient and family to complete a medication history. If necessary, pharmacogentic or other clinical tests are ordered. If tests are ordered, a second visit occurs to review the results with the patient’s family. Recommendations are provided to the referring physician after each appointment. Rational: The reason for reviewing our experience is to understand which patients are referred and determine which tools have been of assistance. We hypothesized that referrals made to an IPT Clinic are frequently related to difficult to explain adverse responses or lack of clinical response to medications and that laboratory tests, including pharmacogenomics, provide guidance for recommendations in drug therapy. Objectives: were two-fold: to describe the referrals made to an IPT Clinic and to describe the laboratory evaluation completed to provide therapy recommendations. Results: The first patient was seen in July 2010. We have seen 279 patients. Demographics: 236 Caucasian, 15 Black, 9 Asian, 1 Pacific Islander, 15 other (11 multiracial). 36 were adopted (5 China, 1 Korean, 27 USA). 213 patients referred by Subspecialists (Top 3: Psychiatry, Gastroenterology, Neurology), 43 patients by Primary Care Providers (182 and 7 patients, respectively referred by internal providers). The greater majority of our patients have behavioral and developmental diagnosis. The next most common diagnoses were gastrointestinal and neurologic. Reasons for referral: 127 ADR, 152 poor medication response, 6 family provided genotype results, 19 genotype requested by family / physician, 17 other. At the time of the first visit, patients were on an average of 5.4 ± 3.72 medications. Common genotyping tests performed include CYP2D6, CYP2C19, CYP2C9, Serotonin 2A/2C receptor, serotonin transporter, DRD3 Receptor, and the DRD4 Receptor. Genotyping was performed in 163 patients (58.4%). For patients whose referring physician was an internal provider, recommendations were accepted 70 patients, partly accepted in 23 patients (49% full/partial acceptance rate). Conclusions: Referrals to our IPT Clinic are frequently related to difficult to explain adverse responses or lack of clinical response to medications. Pharmacogenetic results have helped provide guidance for recommendations in drug therapy.
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Section on Advances in Therapeutics and Technology Program| May 01 2018
Individualized Pediatric Therapeutics Clinic: Action in Practice
Cristy Eidelman, M.D, FAAP;
Tracy Sandritter, Pharm D, BCPPS;
Pediatrics (2018) 142 (1_MeetingAbstract): 798.
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Cristy Eidelman, Tracy Sandritter, Jennifer Lowry; Individualized Pediatric Therapeutics Clinic: Action in Practice. Pediatrics May 2018; 142 (1_MeetingAbstract): 798. 10.1542/peds.142.1MA8.798
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