It was one year ago that Millennium Laboratories introduced a new genetic test that one doctor hailed as the “Holy Grail” of patient drug therapy: a test that could tell physicians why some patients react poorly or differently to pain medication.
Some even predicted it would revolutionize the field of pain management.
Flash forward a year to PAINWeek in Las Vegas, the same health care conference where Millennium announced the launch of its pharmacogenetic (PGT) test in 2012.
At a breakfast symposium attended by hundreds of pain management practitioners, a Millennium representative asked for a show of hands. How many had used the PGT test in the past year?
Only a handful of hands went up.
The revolution is off to a slow start.
“We know that managing pain patients is a trial and error approach many times,” says Jennifer Strickland, PharrmD, Millennium’s vice president of clinical strategy.
“I think that as the literature evolves and as we learn more about this area, it will become more standard of care.”
Millennium is one of the nation’s largest urine drug screening companies, but PGT is a saliva-based test, designed to detect four genetic variations in enzymes that influence how a patient metabolizes opioid pain medications. PGT test results could help physicians modify dosages, anticipate side effects or change medications for patients who don’t respond well to pain management.
“We all have genetic differences that influence how we respond to drugs. And when you’re in pain, the faster you can get to the right answer is critical,” Strickland told National Pain Report.
“I think once physicians and clinicians understand the science behind PGT and how it can impact patient care, I think its automatic that physicians and clinicians will incorporate it into their practice, because they’ll realize than can treat patients more effectively early on in their treatment plan.”
The science behind pharmacogenetic testing is still emerging. This week Millennium unveiled the results of a small study involving 104 patients at a Louisiana pain clinic. All had histories of a poor response to pain management — opioids that didn’t work or had unwanted side effects.
PGT testing of the Louisiana patients found that over 90 percent had an abnormal gene that could effect their ability to metabolize opioids.
“Pharmacogenetic testing is an important clinical tool that allows me to offer more personalized treatment to my patients,” said Eric Ehlenberger, MD, of the Accurate Clinic in Kenner, LA.
“These genetic variations can increase the likelihood of a bad outcome, ranging from lack of efficacy to serious toxicity. Though more study is needed, the results point to PGT as a useful tool for pain practitioners and the personalized treatment planning it enables.”
In the general population, only 10 to 20 percent might be expected to have the same genetic variations as the pain patients in Louisiana.
“If you only think 10 percent of your patients are abnormal, you may do the trial and error approach and see which patients have abnormal outcomes and you might test those,” says Strickland.
“But when you know going into a specialty practice that a majority of your patients have a genetic abnormality, it would behoove the physician to essentially know that upfront, to choose those medications more appropriately.”
One factor that may be holding up the early adoption of PGT testing is the cost. It ranges from $46 to $400 a test, and the testing is not always covered by insurance.
“Providers always want to know what’s the cost, based on the benefits they’re going to get,” Strickland says.
“But when you consider the cost of taking a patient from one drug to a second drug to a third drug to a fourth drug, the cost of that can sometimes be outstanding for the payer, the patient and sometimes even to the provider. And so, as we learn more about PGT, we may see its a more cost effective tool.”