LCD Reference Article Response To Comments Article

Response to Comments: MolDX: HLA-DQB1 0602 Testing for Narcolepsy

A54813

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Article ID
A54813
Original ICD-9 Article ID
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Article Title
Response to Comments: MolDX: HLA-DQB1 0602 Testing for Narcolepsy
Article Type
Response to Comments
Original Effective Date
02/15/2016
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The comment period began on 10/13/15 and ended on 11/27/2015. Comments were received from the provider community. The notice period begins on 12/31/2015 and ends 2/14/2016. The LCD becomes final on 2/15/2016.”

Response To Comments

Number Comment Response
1 The commenter disagrees with the following statements: 1. “At this time there is no clinical utility for genetic testing or HLA-DQB1*06:02 typing in the diagnosis or treatment of narcolepsy” (Indication and Limitations of Coverage section, page 1). 2. “Although research suggests a strong association between HLA-DQB1*06:02 and narcolepsy risk, at this time there is no evidence for any diagnostic utility of HLA typing” (Background section, page 2). The commenter states that “In this regard, several studies have shown that genetic factors play a role on narcolepsy but are neither necessary nor sufficient to cause narcolepsy. One of these genetic factors, the presence of the HLA-DQB1*06:02 allele has been shown to be one of the most important predisposing genetic factors with 85-95% of narcolepsy patients carrying this gene. Moreover, homozygosity for HLA-DQB1*06:02 (two copies of the gene) carry a greater risk than heterozygosity (one copy of the gene). Thus, the genetic risk of developing narcolepsy is not fully explained by HLA-DQB1*06:02 as there are many patients with narcolepsy who do not carry this gene. However, genetic testing for HLA-DQB1*06:02 is useful additional test in the diagnosis of narcolepsy.” As the commenter states, “genetic factors pay a role in narcolepsy, but are neither necessary nor sufficient to cause narcolepsy”. Given this statement we do not see how genetic testing for HLA-DQB1*06:02 provides useful (clinically actionable) information? The statement corroborates that HLA-DQB1*06:02 is an association, not a cause, of narcolepsy, and that testing does not confirm a diagnosis of narcolepsy. The policy will not be changed.
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