Personalizing Alopecia Areata Care With Pharmacogenetic Testing

This video is sponsored by Sun Pharma. Its content is editorially independent of the sponsor.

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In this episode of Topical Conversations, Natasha Mesinkovska, MD, joins Tracee Blackburn, PA-C, to discuss personalized care in dermatology and how pharmacogenetic testing can help inform treatment selection for patients with alopecia areata (AA).

Rethinking personalized care

For Mesinkovska, personalized care begins with a shift in perspective: rather than asking what the treatment is for a particular disease, clinicians can consider what the appropriate treatment is for the individual patient. Blackburn agrees, emphasizing the importance of looking beyond the diagnosis on the chart and considering each patient holistically.

This individualized approach is particularly relevant as dermatologic treatment options become increasingly targeted and clinicians have more tools available to help guide treatment decisions.

Pharmacogenetic testing before deuruxolitinib

Mesinkovska and Blackburn explore pharmacogenetic testing through the lens of deuruxolitinib treatment for AA. Before initiating deuruxolitinib, patients undergo CYP2C9 genotype testing to determine how they metabolize the medication.

Mesinkovska explains that CYP2C9 is an enzyme involved in metabolizing deuruxolitinib. Genetic variation can affect CYP2C9 activity, meaning patients may metabolize the medication differently. Testing before treatment allows clinicians to identify patients whose CYP2C9 genotype may affect their exposure to the drug.

Blackburn frames the test for patients as an additional step in making sure the selected therapy is appropriate for them, with Mesinkovska adding that, unlike routine laboratory monitoring, CYP2C9 genotype testing is performed at baseline and does not need to be repeated.

Understanding the results

Mesinkovska encourages clinicians not to be intimidated by the genetic component of the test. She breaks its use down into 3 basic questions: What does the test tell us? How is it ordered and reported? And how do we interpret the report?

Results categorize patients according to their CYP2C9 metabolizer status. Dr Mesinkovska discusses normal, intermediate, and poor metabolizers and how the result can inform whether treatment with deuruxolitinib is appropriate.

Importantly, she stresses what the test does not do: It does not predict whether a patient will experience hair regrowth. Rather, it identifies differences in drug metabolism that may place certain patients at risk for increased exposure to the medication.

Incorporating testing into clinical workflows

Although adding another pretreatment test may initially seem like an additional logistical hurdle, both clinicians describe pharmacogenetic testing as readily incorporated into their existing workflows.

Blackburn notes that familiarity with the appropriate laboratory test and ordering process can make the additional step relatively straightforward. She also sets expectations with patients that results may take approximately 2 weeks, helping prevent concern when other baseline laboratory results return sooner.

For Mesinkovska, the turnaround time has not represented a significant treatment delay. The testing period often overlaps with other steps already required before treatment initiation, including prior authorization and other baseline evaluations.

She also emphasizes that pharmacogenetic testing is only one component of treatment selection. Clinicians must still review a patient's medications, medical history, and potential contraindications before initiating therapy.

Looking toward more individualized dermatologic care

Mesinkovska and Blackburn close by reflecting on the broader movement toward more precise, individualized dermatologic care. As diagnostic and therapeutic options continue to advance, pharmacogenetic testing represents another tool clinicians can use to better understand whether a particular treatment is appropriate for an individual patient.