Mutations in certain genes may increase drug metabolism or decrease drug sensitivity.
Findings from a recent study suggest that certain genetic mutations can impact drug metabolism, and could potentially be the cause of high hospitalization rates in older adults who take multiple medications.
Many patients must take multiple medications for multiple diseases, especially elderly patients. This phenomenon is called polypharmacy. While these medications can be safe on their own, taking multiple medications drastically increases the risk of drug-drug interactions.
These interactions can cause serious complications that may result in hospitalization, or even death in some cases. Many drug interactions are already known, but some are still unknown.
New research indicates that genetic changes may also impact the rate of drug-related adverse events in this population. For the study, published by Pharmacogenetics and Personalized Medicine, investigators hypothesized that older adults taking many medications that had increased hospitalization rates would also have certain genetic mutations.
They believe that these mutations would alter drug metabolism or decrease drug sensitivity compared with individuals with less hospitalizations. To explore this, investigators used pharmacogenetic testing to identify multiple genes in older adults with polypharmacy.
Included in the study were 6 older adults admitted to the hospital 3 or more times over the past 2 years, and 6 control patients with less hospitalizations who were the same age. The average age of both groups was 77-years-old, and patients were taking an average of 14 medications, according to the study.
The researchers determined any mutations in the CYP2C19, CYP2C9, VKORC1, CYP2D6, CYP3A4/5 genes in each patient. In the group with higher hospitalizations, each patient had 1 or more of the mutations in the specified genes that impact drug metabolism and sensitivity.
The investigators discovered that no patients in the control group that had any of the mutations.
Since there was such a small patient population included in this study, the investigators plan to conduct a much larger clinical trial. In this larger trial, they aim to determine whether identifying these mutations could potentially improve patient outcomes, and prevent additional hospitalizations.
If pharmacogenetic testing proves effective in the larger study, physicians may have an effective way to prevent increased healthcare utilization and improve outcomes.
“Although this was a very small pilot study, the findings suggest that routine testing for these gene variants could improve health outcomes for older adults taking multiple medications,” said lead author of the study Joseph Finkelstein, MD, PhD. “In dentistry, for example, pharmacogenetic testing could be part of a personalized approach in which clinicians select pain medications that are most effective and least risky for each patient.”