May 18, 2020 -Using precision medicine approaches to tailor heart disease therapies could lead to more cost-effective treatments and improved patient outcomes, according to a study led by researchers at the University of Alabama at Birmingham (UAB).
Patients who experience a heart attack have sharply reduced blood flow in coronary arteries, as well as a high risk of heart failure or death. Coronary angioplasty, a procedure to open narrowed or blocked arteries in the heart, and percutaneous coronary intervention (PCI) can restore blood flow to minimize heart damage. These procedures reduce the risk of subsequent major adverse cardiovascular events (MACE), which include heart attacks, strokes, or death.
After these procedures, providers have to make a treatment decision. After PCI, all patients receive two antiplatelet agents for up to one year. The most commonly used antiplatelet combination after PCI is aspirin and clopidogrel. Clopidogrel is converted to its active form by an enzyme called CYP2C19, but patients respond to this treatment differently depending on their genetic makeup.
Over 30 percent of people have loss-of-function variants in the CYP2C19 gene that decreases the effectiveness of clopidogrel. These patients may not get the full benefit of clopidogrel, which would increase their risk of MACE. The FDA recommends that providers consider different treatments for these individuals, such as prasugrel or ticagrelor, to replace clopidogrel.
In 2018, UAB and researchers at nine universities across the US showed that patients with loss-of-function variants who were treated with clopidogrel had elevated risks. The study revealed that there was a twofold risk of MACE in PCI patients, and a threefold risk for MACE among patients with acute coronary syndrome who received PCI, as compared to patients prescribed prasugrel or ticagrelor instead of clopidogrel.
While prasugrel and ticagrelor are not influenced by loss-of-function variants and can substitute for clopidogrel, these drugs are much more costly and can bring a higher risk of bleeding.
Using this real-world data, the research team set out to conduct an economic analysis of the best treatments for heart disease patients. The study compared three main strategies: treating all patients with clopidogrel, treating all patients with ticagrelor, and genotyping all patients and using ticagrelor in those with loss-of-function variants.
The group considered differences in event rates for heart attacks and stent thrombosis in patients receiving clopidogrel versus ticagrelor versus genotype-guided therapy, during the one-year period following PCI. They also considered medical costs from events like admissions, procedures, medications, clinical visits, and genetic testing. The study used an economic measure known as the quality-adjusted life year (QALY).
First, we looked at which strategy provided the highest QALY, Limdi said. The QALY is the gold standard for measuring benefit of an intervention in our case, genotype-guided treatment compared to treatment without genotyping. Universal ticagrelor and genotype-guided antiplatelet therapy had higher QALYs than universal clopidogrel so those are the best for the patient.
Researchers then analyzed whether those interventions that have higher QALYs were also reasonable from a cost perspective, which includes a payers or patients willingness to pay.
In our case, the payor would recognize that ticagrelor is more expensive than clopidogrel $360 per month vs. $10 per month and there is a $100 cost for each genetic test, Limdi said. So, from the payor perspective, the more effective strategy (one with a higher QALY) if more expensive (higher cost) would have to lower the risks of bad outcomes like heart attacks and strokes for the gains in QALY that are at, or below, the willingness-to-pay threshold.
A measure called incremental cost-effectiveness ratios (ICERs) assesses the incremental cost of the benefit, or improvement in QALY. In the US, a treatment is considered cost-effective if its associated ICER is at or below the willingness-to-pay threshold of $100,000 per QALY.
In our assessment, the two strategies with the highest QALY had very different ICERs, Limdi said. The genotype-guided strategy was cost-effective at $42,365 per QALY. Universal ticagrelor was not; it had an ICER of $227,044 per QALY.
The study results demonstrate the effectiveness of genotyping and precision medicine strategies for tailoring treatments and improving patient outcomes.
We showed that tailoring antiplatelet selection based on genotype is a cost-effective strategy, said Nita Limdi, PharmD, PhD. Support is now growing to change the clinical guidelines, which currently do not recommend genotyping in all cases. Evidence like this is needed to advance the field of precision medicine.
- Largest-Ever Study of Prostate Cancer Genomics in Black Men IDs Potential Targets for Precision Therapies - UCSF News Services - July 12th, 2020
- Researchers Discover Genetic Variants Linked to Type 2 Diabetes - HealthITAnalytics.com - July 12th, 2020
- Summerville Medical celebrates 1 year anniversary of obstetric consolidation - Journalscene.com - July 12th, 2020
- Researchers at U of T use stem cells to grow functional blood vessel cells found in liver - News@UofT - July 12th, 2020
- The Wilderness of Rare Genetic Diseases and the Parents Navigating It - The New York Times - July 12th, 2020
- This Company Wants to Rewrite the Future of Genetic DiseaseWithout Crispr Gene Editing - WIRED - July 12th, 2020
- Could induced pluripotent stem cells be the breakthrough genetics has been waiting for? - The New Economy - July 12th, 2020
- An intriguingbut far from provenHIV cure in the 'So Paulo Patient' - Science Magazine - July 12th, 2020
- First Extensive Validation Study of Saphyr for Constitutional Genetic Disorders by European Consortium Shows 100% Concordance to Standard Cytogenetics... - July 12th, 2020
- MyoKardia: The Precision Cardiac Medicine Company with Diversity and Inclusion at its Heart - BioSpace - July 12th, 2020
- From pandemic to rare disease, medical innovation is the answer - EURACTIV - July 12th, 2020
- COVID-19 Now Research Focus Of Health Database That Has Several Wisconsin Partners - WUWM - July 12th, 2020
- If you have this blood type, studies show youre at higher risk for the coronavirus - San Francisco Chronicle - July 12th, 2020
- How Accurate Are the Coronavirus Diagnostic and Antibody Tests? - Healthline - July 12th, 2020
- NIH researchers reframe dog-to-human aging comparisons - National Institutes of Health - July 12th, 2020
- The Prostate Cancer Foundation Collaboration With Pan-Cancer Consortium Clarifies And Promotes Consistent Use Of Common Terms For Biomarker And... - July 12th, 2020
- Worldwide genome research could change the course of medical history - The Big Smoke Australia - July 12th, 2020
- Post-PCI Mortality Higher in Blacks vs Whites, Comorbidities Aside - Medscape - July 12th, 2020
- A COVID-19 vaccine may come soon. Will the blistering pace backfire? - Science News - July 12th, 2020
- In the hunt for ALS treatments, researchers find promise in silencing genes - BioPharma Dive - July 12th, 2020
- Gene therapy innovations: Sarepta and Codiak partner on exosomes - Pharmaceutical Technology - July 12th, 2020
- NIH Funds Research to Understand How Genomics of Diverse Populations Affect Clinical Care - AJMC.com Managed Markets Network - July 11th, 2020
- ACMG's Genetics in Medicine Journal Receives Impact Factor of 8.904 for 2019--Journal is Ranked 13th of 177 Journals in Genetics & Heredity -... - July 11th, 2020
- Parasitic worms use their keen senses to wriggle through their hosts - University of Wisconsin-Madison - July 11th, 2020
- BridgeBio Pharma's Phoenix Tissue Repair to Highlight Interim Phase 1/2 Study Data in a Presentation at the Society for Pediatric Dermatology's 45th... - July 11th, 2020
- Genetic testing and hitching a ride with the British; In The News for July 10 - Medicine Hat News - July 11th, 2020
- A WHO-led mission may investigate the pandemic's origin. Here are the key questions to ask - Science Magazine - July 11th, 2020
- Scientists need to track genetic diversity of COVID-19 for effective vaccine: U of M study - CTV News Winnipeg - July 11th, 2020
- Global wildlife surveillance could provide early warning for next pandemic - Washington University School of Medicine in St. Louis - July 10th, 2020
- Bennett named chief of breast imaging section - Washington University School of Medicine in St. Louis - July 10th, 2020
- Edgewise Therapeutics Appoints Abby H. Bronson, M.B.A., as Vice President, Patient Advocacy and External Innovation - Business Wire - July 10th, 2020
- Search for cure for common parasitic infection focus of $5.5 million NIH grant - Washington University School of Medicine in St. Louis - July 10th, 2020
- Stoke Therapeutics Announces Publication of Data in the Journal Nature Communications That Support the Company's Proprietary Approach to Addressing... - July 10th, 2020
- Trending: CRISPR And CRISPR-Associated Genes Market Research Key Players, Industry Overview and forecasts to | Thermo Fisher Scientific, Editas... - July 10th, 2020
- Europe Genetic Testing Services Market is expected to reach US$ 5840.9 Million by 2027 with CAGR of 11.4%. - Owned - July 10th, 2020
- Supreme Court to rule on constitutionality of genetic discrimination law - Medicine Hat News - July 10th, 2020
- Genetic fingerprints of first COVID19 cases help manage pandemic - News - The University of Sydney - July 10th, 2020
- Drug for Inherited ALS Shows Promise in Early-stage Trial - Technology Networks - July 10th, 2020
- Myriad Announces Partnership with OptraHEALTH to Deliver Gene a New AI Based Information Tool for Hereditary Cancer Patients - BioSpace - July 6th, 2020
- Children's National Medical Center and AWS partner for genome project targeting COVID-19 - SiliconANGLE - July 6th, 2020
- Sarepta Therapeutics Announces Retirement of Sandy Mahatme, Chief Financial Officer and Chief Business Officer - BioSpace - July 6th, 2020
- Movers & Shakers, July 3 | BioSpace - BioSpace - July 6th, 2020
- The Future of Medicine Is Bespoke - Fair Observer - July 6th, 2020
- July: Genome sequencing rare diseases | News and features - University of Bristol - July 6th, 2020
- Dropping Race-Based eGFR Adjustment Gains Traction in US - Medscape - July 6th, 2020
- A New Generation of Coronavirus Tests Is Coming. Here's What to Expect. - The New York Times - July 6th, 2020
- Male fruit flies' decline in fertility with age is not only driven by changes in sperm - Mirage News - July 6th, 2020
- In the Future, Lab Mice Will Live in Computer Chips, Not Cages - Medscape - July 6th, 2020
- For cancer treatment and more, genetic-based precision medicine holds a lot of promise - Connecticut Magazine - May 31st, 2020
- Drug factories: GMOs and gene editing are poised to transform medicine. Here's how. - Genetic Literacy Project - May 31st, 2020
- How to know your risk factors for hypertension and whether high blood pressure is genetic - Insider - INSIDER - May 31st, 2020
- Venture capital found its footing in biotech. Then came the virus. - BioPharma Dive - May 31st, 2020
- Israeli Lab: Drugs For Gaucher Disease May Work Against Coronavirus, Other Viral Infections | Health News - NoCamels - Israeli Innovation News - May 31st, 2020
- Rapid Growth on Genetic Testing Market with COVID-19 Impact Analysis, Top Key Companies like Abbott Laboratories Bio-Rad Laboratories Inc.,... - May 31st, 2020
- insideHPC Special Report: HPC and AI for the Era of Genomics - insideHPC - May 31st, 2020
- More insight into the cytokine storm caused by Covid-19 could lead to a treatment - Health24 - May 31st, 2020
- UCalgary researchers launch 360-degree study of children and COVID-19 - UCalgary News - May 31st, 2020
- 4000 Years of contact, conflict and cultural change had little genetic impact in Near East - University of Birmingham - May 31st, 2020
- Precision Medicine Market Overview By Growing Demands, Trends And Business Opportunities 2020 To 2027 - Cole of Duty - May 31st, 2020
- NOT REAL NEWS: A look at what didn't happen this week - wausaupilotandreview.com - May 31st, 2020
- Colonizing Mars may require humanity to tweak its DNA - Space.com - May 19th, 2020
- Complement genes add to sex-based vulnerability in lupus and schizophrenia - Newswise - May 19th, 2020
- 23andMe Is Trying to Crack the Genetic Code Behind the Coronavirus - Motley Fool - May 19th, 2020
- Global Molecular Diagnostics Industry 2019-2029: Genetic Disorders, Cardiovascular Disorders, Infections and Cancer - Yahoo Finance UK - May 19th, 2020
- Prominent Cancer Researcher to Join DRI and Renown Health - GlobeNewswire - May 19th, 2020
- Research Roundup: HIV vaccination, diabetes two-in-one injection, hybrid fish genetics - The Stanford Daily - May 19th, 2020
- Singapore researches discover specific gene linked to Asian Lung Cancer - BSA bureau - May 19th, 2020
- Grant will help scientists break new ground in gene editing - Newswise - May 19th, 2020
- Genomic Medicine Market 2020 | Know the Latest COVID19 Impact Analysis And Strategies of Key Players: Ingersoll Rand, Johnson Controls, Daikin, United... - May 19th, 2020
- Dyne Therapeutics Accelerates Programs in Facioscapulohumeral Muscular Dystrophy (FSHD) with Exclusive Licensing of Technologies to Target Genetic... - May 19th, 2020
- Coronavirus immunity passports could create a world of 'us and them'. But here's why they make sense - Genetic Literacy Project - May 19th, 2020
- New Stem Cell-Based Topical Solution Helps Bald People Regrow Hair - SciTechDaily - May 19th, 2020
- Scientists race to find a cure or vaccine for the coronavirus. Here are the top drugs in development - CNBC - May 19th, 2020
- WHITEHALL ANALYTICA THE AI SUPERSTATE: Part 2 Is COVID-19 Fast-Tracking a Eugenics-Inspired Genomics Programme in the NHS? - Byline Times - May 19th, 2020
- CRISPR And CRISPR-Associated (Cas) Genes Market Size, Share, Trends and Forecast 2026 by Major Players and Business Opportunities Caribou... - May 19th, 2020
- Researchers: Disease affecting kids could be in the genes - Newsday - May 19th, 2020
- From Competition To Sharing: How Her Childrens Rare Disease Led Sharon Terry To Revolutionize Medical Research - Forbes - May 9th, 2020
- Infection rates may have links to cancer - Medical News Today - May 9th, 2020
- Twin peeks: Stanford inherits twin registry, expanding research options - Stanford Medical Center Report - May 9th, 2020
- Management of Fertility and Hormonal Health in Women at Risk for Hereditary Gynecologic Cancers - Endocrinology Advisor - May 9th, 2020