Comprehensive Behavioral Health Management
SureGene™ is a tool designed to assist healthcare providers in personalizing and improving outcomes of pharmacotherapy. The management of behavioral health conditions is particularly challenging due to a large selection of therapeutic agents, high individual treatment variability, lengthy medication evaluation times, and a lack of effective treatment selection strategies. SureGene provides a much needed framework from which to guide medication selection and dosing decisions.
Comprehensive, personalized behavioral health treatment through genetics
Genetic testing is rapidly becoming the preferred strategy for prescribing psychiatric medications, by showing improved outcomes through:
- Increased efficiency of treatment by decreased number of failed medication trials
- Improved medication safety, efficacy and tolerability
- Improved patient treatment satisfaction, with increased medication compliance
- Identification and prevention of costly adverse drug reactions and hospitalizations
SureGene Medications & Gene Targets
Using SureGene in Clinical Practice
When should SureGene be used?
Key Clinical Decision Points:
- Initial Medication Selection: For drug-naïve patients or patients who are not currently on medication
- Medication Change: Poor efficacy, tolerability, or patient satisfaction with existing medications
- Severe Treatment Failure: Exacerbations of psychosis, especially those that lead to hospitalization
- Polypharmacy patients
- Pediatric patients
SureGene Provides Information for Common Clinical Questions:
- What antipsychotics are MORE likely to produce clinical improvement for my patient?
- What antipsychotics are LESS likely to produce clinical improvement for my patient?
- Will olanzapine give my patient the greatest chance for clinical improvement?
- Is my patient at increased risk for antipsychotic-associated weight gain?
- Do consensus recommendations suggest avoiding risperidone due to altered metabolism?
- Is my patient at increased risk for a serious adverse reaction to carbamazepine and related drugs?
- Are SSRIs likely to have decreased efficacy and increased risk of side effects?
- Do consensus data recommend avoiding amitriptyline and venlafaxine due to altered metabolism?
- Does my patient adequately absorb folate and metabolize it into L-methylfolate?
- What drugs can I use as directed for my patient?
- What drugs should I consider adjusting the dose for my patient?
- Is my patient at increased risk of an adverse event due to warfarin treatment?
SureGene Targets for Antipsychotic Treatment Selection
- PharmGKB Web site. http://www.pharmgkb.org. Accessed September 18, 2012.
- Ramsey TL, Meltzer HY, Brock GN, et al. Evidence for a SULT4A1 haplotype correlating with baseline psychopathology and atypical antipsychotic response. Pharmacogenomics. 2011;12(4):471-480.
- Liu Q, Ramsey TL, Meltzer HY, Massey BW, Padmanabhan S, Brennan MD. Sulfotransferase 4A1 haplotype 1 (SULT4A1-1) is associated with decreased hospitalization events in antipsychotic-treated patients with schizophrenia. Prim Care Companion CNS Disord. 2012;14(3):doi:10.4088/PCC.11m01293.
- Ramsy TL, Liu Q, Brennan MD. Replication of SULT4A1-1 as a pharmacogenomic marker of olanzapine response and evidence lower weight gain in the high response group. Pharmacogenomics. 2014;15(7):933-939.
- Ramsey TL, Brennan MD. Glucagon-like peptide 1 receptor (GLP1R) haplotypes correlate with altered response to multiple antipsychotics in the CATIE trial. Schizophr Res. 2014;160(1-3):73-9. doi: 10.1016/j.schres. 2014.09.038. Epub 2014 Oct 18.
As with any laboratory test, SureGene should not be used as the sole means of treatment decision making, and should be regarded by the ordering clinician as adjunctive to the overall patient management strategy. These genotyping results do not eliminate the necessity to account for non-genetic factors that can influence dose requirements for or responses to medications that are metabolized by these enzyme systems. Drug-drug interactions that lead to enzymatic inhibition or induction may lead to altered metabolism. Results should always be interpreted in context with the clinical picture and all co-administered medications.