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Pharmacogenomics: Advances in Personalized Medicine to Improve Mental Health & Disability Management

Dr. Tyler Amell

October 18, 2017

Schedule 2 Employers’ Group Conference

Pharmacogenomics: Using Personalized Medicine to Improve Mental Health

Demystifying the medical science

The journey from the laboratory workbench to today’s workplaces

Why you should care Health and productivity, temporary work disability, disability prevention

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Physical Health

Examples:

Neuropathic Pain,

Cardiovascular, Cholesterol

Mental Health

Examples:

Anxiety,

Depression

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3 Most Important Takeaways for You

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1Disability

Prevention

2Early Intervention

3 Recovery &

Reintegration

Presenteeism? Stay at Work? Absenteeism?

Pharmacogenomic Impact

What’s in a Word?

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Pharmacogenetics Pharmacokinetics

Pharmacogenomics

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Chemistry and Biology Basics

Human Genome Project

Genetic Variance in

Drug Metabolism

Quicker Return to Function

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Personalized Medicine

Precision Medicine

Personalized Healthcare

Safer – Less Adverse Events

Improved Outcomes

Improved Compliance

Quicker Return to Function

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DNA

Like your fingerprint,

your liver and the enzymes

it contains is unique to you…

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One Size Does Not

Necessarily Fit All…

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Healthcare

services are not

personalized

Evidence-

Informed

Practice

(Evidence-Based

Practice)

Based upon

research

conducted

without genetic

data

Why is this Important for You?

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55%

EM:Extensive or

Normal

Metabolizer

5%

UM:Ultrarapid

Metabolizer

30%

IM:Intermediate

Metabolizer

10%

PM:Poor Metabolizer

*CYP2D6 Enzyme – Involved in 20% of all drug metabolism, not just SSRIs

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Mental Health – Pharmaceutical Interventions

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BENZODIAZEPINES (Xanax, Valium, Ativan)

BETA BLOCKERS

TRICYCLIC ANTIDEPRESSANTS (Amitriptyline, Tofranil,

Norpramin)

MONOAMINE OXIDASE INHIBITORS (MAOIs) (Nardil, Parnate)

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

(SSRIs) (Prozac, Zoloft, Paxil, Celexa)

SEROTONIN-NOREPINEPHRINE REUPTAKE

INHIBITORS (SNRIs) (Effexor)

ANTICONVULSANTS (Lyrica, Neurontin)

TRICYCLIC ANTIDEPRESSANTS (Amitriptyline , Tofranil,

Norpramin)

MONOAMINE OXIDASE INHIBITORS (MAOIs) (Nardil, Parnate)

SELECTIVE SEROTONIN REUPTAKE INHIBITORS

(SSRIs) (Prozac, Zoloft, Paxil, Celexa)

SEROTONIN-NOREPINEPHRINE REUPTAKE

INHIBITORS (SNRIs) (Effexor)

Anxiety Depression

Drug Analytics – A Cautionary Tale

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Physical Health

Examples:

Neuropathic Pain,

Cardiovascular, Cholesterol

Mental Health

Examples:

Anxiety,

Depression

BENZODIAZEPINES (Xanax, Valium, Ativan)

BETA BLOCKERS

TRICYCLIC ANTIDEPRESSANTS (Amitriptyline,

Tofranil, Norpramin)

MONOAMINE OXIDASE INHIBITORS

(MAOIs) (Nardil, Parnate)

SELECTIVE SEROTONIN REUPTAKE

INHIBITORS (SSRIs) (Prozac, Zoloft, Paxil, Celexa)

SEROTONIN-NOREPINEPHRINE REUPTAKE

INHIBITORS (SNRIs) (Effexor)

ANTICONVULSANTS (Lyrica, Neurontin)

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Pharmacogenomics: Case Study in Personalized Medicine

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Demographic: 42 year old male

Employment Status: FT, Professional

Employment Notes: Highly engaged, high achiever, no history of absenteeism/disability

Case Notes: Sudden onset of neuropathic pain

Debilitating acute, episodic pain

High degree of chronic pain

Loss of nerve function in impacted areas

No time lost from work, poster-child for presenteeism

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TimeMAY JUL SEP NOV JAN MAR MAY JUL SEP

Gabapentin (Neurontin)

Aventyl 10mg (Nortriptyline)

Pantoprozole

Aventyl 25mg (Nortriptyline)

Almotriptan

MH-NP GI NP ONLY

Diclofenac

Piroxicam

Tecta

Indomethacin

A Pathway to

Relief

These wasted costs,

and time could have

been avoided, with a

much quicker return

to function!

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PharmacogenomicsSample Reportto Attending Physician and Pharmacist

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Pharmacogenomics: How Personalized Medicine Works

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DNA ResultsWorker was suffering from anxiety or depression? MDD? TRD?

What If… Worker was not working during this time?

Absenteeism vs. Presenteeism

What if co-morbidities developed?

What could the medication costs be?

What could the disability costs be?

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Benefits to You

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Plan

Sponsors

Plan

Members

Some Results – 13:1 ROI

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Quicker Return to Function

1/3 Disability Duration7% on Drug Costs

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3 Most Important Takeaways for You

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1Disability

Prevention

2Early Intervention

3 Recovery &

Reintegration

Presenteeism? Stay at Work? Absenteeism?

Pharmacogenomic Impact

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Thank you Dr. Tyler AmellPartnertamell@morneaushepell.com