Friday, July 7, 2017

Curators' Favorite Papers

The Impact of Whole-Genome Sequencing on the Primary Care and Outcomes of Healthy Adult Patients: A Pilot Randomized Trial

Jason L. Vassy, MD, MPH, SM; Kurt D. Christensen, PhD, MPH; Erica F. Schonman, MPH; Carrie L. Blout, MS, CGC; Jill O. Robinson, MA; Joel B. Krier, MD; Pamela M. Diamond, PhD; Matthew Lebo, PhD; Kalotina Machini, PhD; Danielle R. Azzariti, MS, CGC; Dmitry Dukhovny, MD, MPH; David W. Bates, MD, MSc; Calum A. MacRae, MD, PhD; Michael F. Murray, MD; Heidi L. Rehm, PhD; Amy L. McGuire, JD, PhD; and Robert C. Green, MD, MPH for the MedSeq Project

This study, published  in the Annals of Internal Medicine, received a lot of attention in prominent media outlets including Wired, STATNPR, Washington Post and Science Magazine. As part of the MedSeq project, 100 healthy adults were recruited by 9 primary care providers (PCP), themselves briefed on genomics and how to refer patients to genetics experts. All patients gave a detailed family history (FH) but were randomized to get either whole genome sequencing (WGS) (WGS +FH) or not (FH) and were surveyed at 6 months regarding follow-up care and well-being. The study authors uncovered monogeneic disease risk (MDR) variants in 11 patients, but only 2 manifested the phenotype (fundus albipunctatus and subclinical porphyria). 48 of 50 subjects had a pharmacogenetic variant in a gene affecting one of five drugs (warfarin, clopidogrel, simvastatin, metformin, and digoxin) and results were added to electronic health records (EHR). PCPs recommended new clinical actions in 16% and 34% of FH and WGS+ FH patients, respectively. At 6 months, 30% and 41% of patients made health behavior changes in the FH and WGS-FH groups, respectively, but no significant differences in self-reported health, anxiety or depression scores emerged between groups. Overall, the authors conclude that identification of MDR variants did not improve short-term health outcomes, and results do not support the routine use of WGS in healthy patients. However, the authors note that the ability of PCPs to adequately manage patient results, their use of EHR, and their appropriate referrals to genetic specialists, as well as self-reported patient well-being after receiving results are encouraging signs that indicate a favorable environment for WGS in future studies and specific clinical care situations.

You can read the study here and more information about the pharmacogenetics of warfarin, clopidogrel, simvastatin, metformin, and digoxin is available at PharmGKB. 




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