A partnership in innovation: Calian Group and Inagene Diagnostics partner to change the lives of Canadians suffering from mental health and pain conditions.
“Canadians suffering from mental health conditions stand to save over $57 billion dollars with use of pharmacogenetic testing; Pharmacogenetic testing can help patients avoid years-long ‘trial and error’ phase of a treatment plan, transforming the experience of Canadians living with physical or psychological pain.”
A Partnership in Innovation to the Lives of Canadians Suffering from Mental Health and Pain Conditions.
It can be argued that, if innovation is needed anywhere in our healthcare system and in employee health plans, it is in the areas of mental health and chronic pain. These conditions impact quality of life more than any other conditions3, and are the leading drivers of substance abuse issues4, suicides5,6,7 absenteeism, disability, and overall healthcare system costs 8, 9
At least one in two Canadians will suffer from mental health or chronic pain condition (or both) in their lifetime 1, 2. The COVID pandemic has greatly exacerbated these issues, with record levels of depression, anxiety, and substance abuse, coupled with difficulty accessing relief via interventional treatments and procedures, and medical or psychological support.
Pain and mental health are closely (genetically) linked, and a diagnosis of one greatly increases the risk of developing the other. When mental health-related symptoms flare up, so typically does pain, and the reverse is also true. Those with chronic pain are twice as likely to commit suicide compared with people without chronic pain. In fact, one of the most effective mechanisms of reducing physical pain is to effectively address any concomitant psychological pain (depression or anxiety), and vice versa. Even the drugs used to treat these conditions overlap to a large extent.
|Those with uncontrolled pain conditions are 3 X more likely to develop depression or anxiety, and those with uncontrolled mental health conditions are 3 X more likely to develop chronic pain.|
While 70% of people with pain or mental health conditions take medications, and nearly a quarter take 3 or more 10, treatment of these conditions is notoriously difficult due to large variations in responses to medications. Drugs and doses that work well for one person are often completely ineffective or cause significant side effects in another.
For years, physicians have had to rely on medication “trial and error” to find something that works for each patient, resulting in up to two-thirds of patients failing the first drug treatment tried, and enduring weeks, months or even years of frustration and expense cycling through multiple drugs and doses.11 - 16
Some populations are at particular risk for BOTH chronic pain and mental health issues, including front line healthcare workers and emergency services, and those who’s work is physical or emotionally stressful in nature (ex. police services, corrections, armed forces personnel.) Women and indigenous populations are also at enhanced risk.
The pandemic has further enhanced relative risk and burden for these populations since early 2020.
Reliance on the traditional “trial and error” method (and the time and frustration involved in this process) often has dire consequences, as time is of absolute essence in treating both pain and mental health conditions. Chances of recovery decrease with each new drug trial, and ongoing symptoms can quickly lead to a progressive “downward spiral” of worsening pain, depression, anxiety, and sleeplessness that is increasingly difficult to recover from, ultimately leading to withdrawal from activities, multiple medications being added on with overlapping side effects, and increasing absences and disability17, 18. Further complicating matters, drug tolerance, which can reduce drug effectiveness further, can rapidly develop, as can drug dependence, with accompanying withdrawal syndromes, potential for abuse, and risk of overdoses.19
In term of promising innovations to improve the odds, drug development in pain and mental health has yielded few new options in the last two decades, with few new drugs on the horizon, meaning that if we are to improve these stats, we must find ways to do better with the treatment options we already have. Enter pharmacogenetic testing or “PGx”.
An alternative to “trial and error”, PGx tests predict which medications and doses are likely to work best for an individual, and which to avoid, based on their DNA.
PGx testing is a simple cheek swab test that can significantly reduce the time and complication needed in finding effective and tolerable treatment for pain and mental health conditions.
Inagene Diagnostics Inc. is a Canadian healthcare company dedicated exclusively to bringing personalized medicine to Canadians suffering from chronic pain and mental health conditions. Inagene produces a unique PGx test focused exclusively in Pain and mental health, testing for more genes, variants, and drugs involved in these conditions than any other provider.
Guiding treatment based on PGx test results has been shown to produce impressive results, with some studies in mental health showing quadruple symptom improvement, double response rates, and nearly double remission rates when treatment is guided with pharmacogenetic testing insights. 20, 21, 22 Studies using PGx test results to guide treatment in pain have shown significantly improved pain scores23, 24, 25, a well as significantly reduced utilization of opioids 24, 25. Other studies have shown emergency room visits and hospital admissions can be reduced by 30 - 40% 26 – 27
Not surprisingly, these clinical improvements drive significant cost savings. Studies have shown savings of $1,000 - $4,000 CAD per year per person in drug costs can also be achieved when using PGx to guide treatment.28 – 31
As the pandemic was continuing to drive epidemic levels of mental health and pain issues across Canada at the end of 2020, Inagene joined forces with one of Canada's largest national health services organizations Calian Health, to explore the real-world impact of pharmacogenetic testing as an innovation with potential to significantly improve the journey and outcomes of Canadians living with pain or mental health issues.
Calian Health is combining innovation with decades of experience in the management of healthcare professionals, primary care and occupational health clinics, pharmaceutical research and Patient Support Programs. Calian is a major employer of front- line health care workers, serving more populations at particular risk for both pain conditions and mental health issues than any other Canadian contract healthcare services company.
*Primacy, a Calian Company, is the largest medical property management provider in Canada, with over 150 clinics offering a wide range of medical services to over 6 million Canadians annually.)
Calian Group Ltd. is one of Canada's largest national health services organizations, and provides contract healthcare services to many of the populations carrying the most significant burden of pain and mental health concerns, including emergency services workers, police and correctional services, and the armed forces.
In 2020-21, Calian supported a ground-breaking “proof of concept” pilot study by Inagene Diagnostics to evaluate the “real-life” value of PGx testing in optimizing treatment of chronic pain and mental health conditions. 50 Canadian patients who were being treated for chronic pain and concurrent mental health conditions were recruited from a busy Primacy* clinic in PEI for the pilot study in late 2020. The Pilot Study Objective: evaluate the impact PGx testing could have on treatment, and on the time and cost burden involved in trialing different medications.
The results of the Pilot Study were compelling and validated outcomes from previous PGx studies:
The PGx test results led to treatment change for over three-quarters of study participants, indicating that even with years of trial and error, the majority had still not found optimal treatment.
According to the treating Physician, having the Inagene insights sooner would have altered treatment “entirely” or “significantly” for over 65 percent of patients, and would have resulted in all 50 patients arriving at a more effective treatment regimen sooner.
It was also determined that having the test results sooner could have saved patients (on average) over 170 weeks of “trial and error” and over $3,000 in wasted drug costs.
The results from the pilot study will be used to raise awareness and enable access to PGx testing for Canadians suffering from mental health and pain conditions, and to bring the cost-saving and productivity benefits to employees and employers in both the private and public sectors.
“Calian is excited to partner with Inagene to support innovative approaches in personalized healthcare. Reducing the time and cost of trialing medications for pain management and mental health treatment has the potential to significantly improve the well-being of Canadians.”
Gordon McDonald, President of Health Services at Calian.
“We need to think differently about how we are addressing treatment for those suffering from pain and mental illness. This pilot illustrates what is possible for Canadians living with physical or psychological pain and how their journey could be transformed for the better through the data-driven insights that pharmacogenetic testing provides.”
Nancy White, CEO of Inagene Diagnostics
- Choiniere M et al. The Canadian STOP-PAIN Project – Part 1: Who are the patients on the waitlists of multidisciplinary pain treatment facilities? Can J
- Tang N, Crane C. Suicidality in chronic pain: Review of the prevalence, risk factors and psychological links. Psychol Med. 2006;36:575–86. [PubMed] [Google Scholar]
- Trivedi MH, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006; 163:28–40
- Souery D, Serretti A, Calati R, Oswald P, Massat I, Konstantinidis A, et al. Switching antidepressant class does not improve response or remission in treatment-resistant depression. J Clin Psychopharmacol. 2011; 31:512–5
- Rush A.J. e al.; Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am. J. Psychiatry 163(11), 1905-1917 (2006)
- Thase M.E. et al.; Remission with mirtazapine and selective serotonin reuptake inhibitors: a meta- analysis of individual patient data from 15 controlled trials of acute phase treatment of major depression. Int. Clin. Psychopharmacol. 25(4), 189-198 (2010)
- Moore RA, Straube S, Derry S, et al. Does this work for you? Individuals, averages, and evidence based medicine. BMJ 2008;337:a2585
- Bandolier. (2007). The Oxford League Table of Analgesic Efficacy. Taken from: http://www.bandolier.org.uk/booth/painpag/Acutrev/Analgesics/Leagtab.html
- Gredin, J et al. Impact of pharmacogenomics on clinical outcomes in major depressive disorder in the GUIDED trial: A large, patient- and rater-blinded, randomized, controlled study. Journal of Psychiatric Research. 2019; 111: 59-67
- Hall – Flavin et al. Using a pharmacogenomic algorithm to guide the treatment of depression. Transl Psychiatry. 2012; Oct; 2 (10)
- Bradley et al. Improved efficacy with targeted pharmacogenetic-guided treatment of patients with depression and anxiety: A randomized clinical trial demonstrating clinical utility. Journal of Psychiatric Research 96 (2018) 100e107101
- Smith D.M. et al.; CYP2D6-guided opioid therapy improves pain control in CYP2D6 intermediate and poor metabolizers: a pragmatic clinical trial. Genet Med. 2019 August ; 21(8): 1842–1850. doi:10.1038/s41436-018-0431-8.
- Hamilton. W.G et al. Using pharmacogenetics to structure individual pain management protocols in total knee arthroplasty. Bone Joint J 2020;102-B(6 Supple A):73–78.
- Senagore AJ et al. Pharmacogenetics-guided analgesics in major abdominal surgery: Further benefits within an enhanced recovery protocol. Am J Surg. 2017 Mar;213(3):467-472. doi: 10.1016/j.amjsurg.2016.11.008. Epub 2016 Nov 22
- Elliott LS, et al. (2017) Clinical impact of pharmacogenetic profiling with a clinical decision support tool in polypharmacy home health patients: A prospective pilot randomized controlled trial. PLoS ONE 12(2)
- Perlis et al. Pharmacogenetic testing among patients with mood and anxiety disorders is associated with decreased utilization and cost: A propensity-score matched study. Depress Anxiety. 2018 Oct;35(10):946-952
- Verbelin M et al. Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet? The Pharmacogenomics Journal (2017) 17, 395–40
- Winner J et al. Combinatorial pharmacogenomic guidance for psychiatric medications reduces overall pharmacy costs in a 1-year prospective evaluation. Current Medical Research & Opinion. Volume 31, 2015 - Issue 9, Pages 1633-1643
- Maciel , Cullors , Lukowiak , Garces . Estimating cost savings of pharmacogenetic testing for depression in real-world clinical settings. Neuropsychiatr Dis Treat. 2018 Jan 8;14:225-230
- Chou WH, et al. Extension of a pilot study: impact from the cytochrome P4502D6 polymorphism on outcome and costs associated with severe mental illness. J Clin Psychopharmacol. 2000;20(2):246–251.
- Gharibo C, Sharma A, Soin A, et al. Triaging interventional pain procedures during COVID-19 or related elective surgery restrictions: evidence-informed guidance from the American Society of Interventional Pain Physicians (ASIPP). Pain Phys. 2020;23:S183–2204.