Pillcheck wins Arthritis Society Canada's 2023 Arthritis Ideator Award: what we learned about precision medicine for arthritis

We are proud that Pillcheck was one of four winners of Arthritis Society Canada's 2023 Arthritis Ideator Awards. The awards recognize innovations that could improve the lives of the more than six million people in Canada living with arthritis. Since the award, we have completed the project it supported. This post shares what the award was for and what we learned.

What are the Arthritis Ideator Awards?

The Arthritis Ideator Awards are part of Arthritis Society Canada's Innovation Strategy. At the second annual event, a pitch-style competition held at the MaRS Discovery District in Toronto on April 20, 2023, seven finalists presented their ideas. A panel of judges selected three winners, FirstHx, Heal Mary and Pillcheck, and a public vote, in which more than 3,500 people took part, chose a fourth, Joints on Point, for the People's Choice Award. Each winner received $50,000 to develop their idea further, along with access to experts from Arthritis Society Canada and its partners (Canadian Healthcare Technology).

What was Pillcheck's project?

Pillcheck's submission focused on DNA-guided prescribing for people living with arthritis. Many of them take several medications for years, to control inflammation and pain and to treat other conditions. With an easy-to-use, at-home cheek swab and a review by an expert pharmacist, Pillcheck helps find the right medication at the right dose and avoid side effects, with results that last a lifetime.

What did we learn about pharmacogenetic testing for arthritis?

We completed the project, and it helped us understand the challenges that people with arthritis face. Three lessons stood out.

1. Pharmacogenetic testing helps with NSAIDs and some non-biologic DMARDs

Pillcheck was helpful for people taking nonsteroidal anti-inflammatory drugs (NSAIDs) and conventional, non-biologic disease-modifying antirheumatic drugs (DMARDs). For these medications, genes affect safety:

• NSAIDs and CYP2C9. Celecoxib, ibuprofen, meloxicam and several other NSAIDs are broken down by the CYP2C9 enzyme. For intermediate and poor metabolizers, the Clinical Pharmacogenetics Implementation Consortium (CPIC) recommends a lower starting dose or a different medication, especially for long-acting NSAIDs such as meloxicam and piroxicam.
• Azathioprine and TPMT and NUDT15. People with reduced activity of these enzymes can build up high drug levels and develop a dangerous drop in white blood cells. CPIC recommends a lower starting dose for intermediate metabolizers and considering a different medication for poor metabolizers with non-cancer conditions.
• Methotrexate and SLCO1B1. There is no guideline that recommends genetic testing before methotrexate, but Pillcheck flags people with greatly reduced (poor) SLCO1B1 function as being at potential risk of higher methotrexate levels and side effects, so that they can be monitored more closely.

Because people with arthritis often take other medications too, such as stomach-protecting proton pump inhibitors, pain medications and antidepressants, a review of the full medication list adds further value. Read more in arthritis medications and your DNA.

2. Reliable genetic predictors for biologics are still missing

Biologic medications, such as TNF blockers, have transformed the treatment of rheumatoid arthritis, but there is still no reliable way to predict which biologic will work for a given person. Studies have reported genetic variants linked to response to TNF blockers and other DMARDs, but these findings have not been consistently replicated, and no guideline recommends a genetic test to choose a biologic. This remains an important gap in precision medicine for arthritis, and finding better predictors is an active area of research.

3. Rheumatologists want more education in pharmacogenetics

Our project also showed a need for deeper education of rheumatologists in the science of pharmacogenetics and the existing clinical evidence. This matches published research: in a Canadian survey, 78% of rheumatologists and rheumatology fellows wanted training in precision medicine, and most felt their training was not sufficient to use these tests in practice. Patients were even more interested, with 97% wanting to learn more.

How can a Pillcheck test help people with arthritis?

With Pillcheck, a pharmacist reviews your results together with all of your current medications, accounts for drug-drug-gene interactions and prepares recommendations that you can share with your rheumatologist, family doctor and pharmacist. A Pillcheck test does not choose a biologic for you, but it can help make NSAIDs, azathioprine and many of the other medications that people with arthritis take safer.

Pillcheck testing is performed in CAP- and COLA-accredited clinical genetic laboratories located in Canada. Pillcheck reports on 24 genes, increasing coverage with new guidelines and drug labels (see the genes tab), and covers 355 medications, which account for over 70% of dispensed prescriptions. The Pillcheck test panel ensures high accuracy for people of non-European and admixed ancestries. Your results last a lifetime, and report updates are free of charge.

Summary

• Pillcheck was one of three judges' winners of Arthritis Society Canada's 2023 Arthritis Ideator Awards, selected from seven finalists.
• Pharmacogenetic testing helps people with arthritis who take NSAIDs and some non-biologic DMARDs, such as azathioprine.
• There are still no reliable genetic predictors of response to biologic medications.
• Rheumatologists want more education in pharmacogenetics and its clinical evidence.

Frequently asked questions

Can a DNA test tell me which biologic will work for me?

Not yet. No genetic test reliably predicts response to biologic medications, and no guideline recommends one for this purpose.

Which arthritis medications can a pharmacogenetic test help with?

It can help with NSAIDs such as celecoxib, ibuprofen and meloxicam, with azathioprine and with many other medications that people with arthritis take, such as proton pump inhibitors, pain medications and antidepressants.

Does a pharmacogenetic test replace regular blood tests?

No. Monitoring blood tests, for example for methotrexate, are still needed. A pharmacogenetic test adds information about how your genes may affect your medications.

References

Canadian Healthcare Technology. Arthritis innovators win $50,000 each. April 26, 2023.

Theken KN, Lee CR, Gong L, et al. Clinical Pharmacogenetics Implementation Consortium guideline (CPIC) for CYP2C9 and nonsteroidal anti-inflammatory drugs. Clin Pharmacol Ther. 2020;108(2):191-200.

Relling MV, Schwab M, Whirl-Carrillo M, et al. Clinical Pharmacogenetics Implementation Consortium guideline for thiopurine dosing based on TPMT and NUDT15 genotypes: 2018 update. Clin Pharmacol Ther. 2019;105(5):1095-1105.

Ramsey LB, Panetta JC, Smith C, et al. Genome-wide study of methotrexate clearance replicates SLCO1B1. Blood. 2013;121(6):898-904.

Plewa P, Ostałowska H, Leciej Z, et al. Genetic polymorphisms in rheumatoid arthritis: from GWAS-identified loci to functional, biomarker, and pharmacogenomic insights. Genes (Basel). 2026;17(10):1175.

Ruel-Gagné S, Simonyan D, Légaré J, et al. Expectations and educational needs of rheumatologists, rheumatology fellows and patients in the field of precision medicine in Canada, a quantitative cross-sectional and descriptive study. BMC Rheumatol. 2021;5(1):52.