Pharmacogenetics in Practice: Estimating the Clinical Actionability of Pharmacogenetic Testing in Perioperative and Ambulatory Settings

Smith, D. Max; Peshkin, Beth N.; Springfield, T. Blaise; Brown, Ryan P.; Hwang, E. Shelley; Kmiecik, Susanna; Shapiro, Richard M.; Eldadah, Zayd; Lundergan, Conor F.; McAlduff, J.; Levin, Bonnie; Swain, Sandra M.

doi:10.1111/cts.12748

Cited by 23 publications

(14 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…20 In a study comprising 600 adult patients seen in outpatient or perioperative cardiology clinics and another studying 122 patients with cardiac catheterization, 16.1% and 20% of patients, respectively, were identified to have a PGx variant that may affect the metabolism of a currently taken medication. [21][22] When exposure inquiry was expanded to medication use in the past 20 years, 80% of English adults had exposure to at least 1 drug with PGx guidance. 23 This compares to the 15% (68/452) of pediatric patients in our study who had a matching prescription within 2 years before or after PGx testing.…”

Section: Results In Context With Previous Literaturementioning

confidence: 99%

“…In a study of Chinese children, up to 9% of patients received at least one medication associated with a CPIC guideline 20 . In a study comprising 600 adult patients seen in outpatient or perioperative cardiology clinics and another studying 122 patients with cardiac catheterization, 16.1% and 20% of patients, respectively, were identified to have a PGx variant that may affect the metabolism of a currently taken medication 21–22 . When exposure inquiry was expanded to medication use in the past 20 years, 80% of English adults had exposure to at least 1 drug with PGx guidance 23 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Retrospective Review of Pharmacogenetic Testing at an Academic Children’s Hospital

Roberts

Wagner

Sandritter

et al. 2020

Clinical Translational Sci

View full text Add to dashboard Cite

There is limited evidence to support pharmacogenetic (PGx) testing in children. We conducted a retrospective review of PGx testing among 452 patients at an academic children's hospital to determine the potential utility of PGx in diseases of childhood and to identify targets for future pediatric pharmacogenetic research. An actionable gene-drug pair associated with the 28 genes tested (Clinical Pharmacogenetics Implementation Consortium (CPIC) level A or B, Pharmacogenomics Knowledge Base (PharmGKB) level 1A or B, or US Food and Drug Administration (FDA) recommendation and a PharmGKB level) was present in 98.7% of patients. We identified 203 actionable gene-drug-diagnosis groups based on the indications for each actionable drug listed in Lexicomp. Among patients with an actionable gene-drug-diagnosis group, 49.3% had a diagnosis where the drug was a therapeutic option and PGx could be used to guide treatment selection. Among patients with an associated diagnosis, 30.9% had a prescription for the actionable drug allowing PGx guided dosing. Three genes (CYP2C19, CYP2D6, and CYP3A5) accounted for all the gene-drug-diagnosis groups with matching diagnoses and prescriptions. The most common gene-drug-diagnosis groups with matching diagnoses and prescriptions were CYP2C19-citalopram-escitalopram-depression 3.3% of patients tested; CYP2C19-dexlansoprazole-gastritis-esophagitis 3.1%; CYP2C19-omeprazole-gastritis-esophagitis 2.4%; CYP2D6-atomoxetine-attention deficit hyperactivity disorder 2.2%; and CYP2C19-citalopram-escitalopram-obsessivecompulsive disorder 1.5%. PGx could be used to guide selection of current treatment options or medication dosing in almost half (48.7%) of pediatric patients tested. Mood disorders and gastritis/esophagitis are promising targets for future study of PGx testing because of the high prevalence of these diagnoses and associated actionable gene-drug pairs in the pediatric population. Pharmacogenetic (PGx) testing, specifically the inquiry into genetic variants in pharmacokinetic or pharmacodynamic pathways involved in medication metabolism or response, is commercially available and being promoted to improve patient outcomes. 1 The level of evidence supporting the clinical utility of testing for variants in individual genes differs, and translation of the test results into clinical practice is complicated. Several organizations, including the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Royal Dutch Association for the Advancement of Pharmacy-Pharmacogenetics Working Group (DPWG), have created detailed, evidence-based, gene-drug clinical

show abstract

Section: Results In Context With Previous Literaturementioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Retrospective Review of Pharmacogenetic Testing at an Academic Children’s Hospital

Roberts

Wagner

Sandritter

et al. 2020

Clinical Translational Sci

View full text Add to dashboard Cite

show abstract

“…6 We hypothesize that patients hospitalized with COVID-19 require medications that are affected by PGx for treatment of acute symptoms and chronic conditions. Although prior investigations have characterized the use of PGx-guided medications in primary care 7 , perioperative, and cardiovascular disease cohorts [8][9][10] we are not aware of prior assessments of the potential value of PGx testing among individuals with COVID-19.…”

Section: More Than 200 Medications Have Pharmacogenomic Information Imentioning

confidence: 99%

Projected Utility of Pharmacogenomic Testing Among Individuals Hospitalized With COVID‐19: A Retrospective Multicenter Study in the United States

Stevenson

Alexander

Palamuttam

et al. 2020

Clinical Translational Sci

View full text Add to dashboard Cite

Many academic institutions are collecting blood samples from patients seeking treatment for COVID-19 to build research biorepositories. It may be feasible to extract pharmacogenomic information from biorepositories for clinical use. We sought to characterize the potential value of multi-gene pharmacogenomic testing among individuals hospitalized with COVID-19 in the United States. We performed a cross-sectional analysis of electronic health records from consecutive individuals hospitalized with COVID-19 at a large, urban academic health system. We characterized medication orders, focusing on medications with actionable pharmacogenomic guidance related to 14 commonly-assayed genes (CYP2C19,

show abstract

“…12 Mission Health developed an outpatient clinic for PGx consultations. 39 40 While the community pharmacy setting has long been a proposed site for integration of PGx into modern healthcare practices, similar barriers persist. 41,42 However, recent studies have demonstrated the viability of PGx work in general in community pharmacies.…”

Section: Introduction and Background Of Pharmacogenomics Across Health-care Settingsmentioning

confidence: 99%

“… 1 Further growth is expected within ambulatory care with pilots such as MedStar Health’s ambulatory-based pilot estimating PGx clinical actionability. 40 …”

Section: Introduction and Background Of Pharmacogenomics Across Health-care Settingsmentioning

confidence: 99%

Pharmacogenomics in the United States Community Pharmacy Setting: The Clopidogrel-CYP2C19 Example

Kisor

Petry

Bright

2021

PGPM

View full text Add to dashboard Cite

Pharmacogenomics (PGx) is expanding across health-care practice settings, including the community pharmacy. In the United States, models of implementation of PGx in the community pharmacy have described independent services and those layered on to medication therapy management. The drug-gene pair of clopidogrel-CYP2C19 has been a focus of implementation of PGx in community pharmacy and serves as an example of the evolution of the application of drug-gene interaction information to help optimize drug therapy. Expanded information related to this drug-gene pair has been provided by the US Food and Drug Administration and clinical PGx guidelines have and continue to be updated to support clinical decision-making. Most recently direct-to-consumer (DTC) PGx has resulted in patient generated sample collection and submission to a genetic testing-related company for analysis, with reporting of genotype and related phenotype information directly to the patient without a health-care professional guiding or even being involved in the process. The DTC testing approach needs to be considered in the development or modification of PGx service models in the community pharmacy setting. The example of clopidogrel-CYP2C19 is discussed and current models of PGx implementation in the community pharmacy in the United States are presented. New approaches to PGx services are offered as implementation continues to evolve and may now include DTC information.

show abstract

Pharmacogenetics in Practice: Estimating the Clinical Actionability of Pharmacogenetic Testing in Perioperative and Ambulatory Settings

Cited by 23 publications

References 43 publications

Retrospective Review of Pharmacogenetic Testing at an Academic Children’s Hospital

Retrospective Review of Pharmacogenetic Testing at an Academic Children’s Hospital

Projected Utility of Pharmacogenomic Testing Among Individuals Hospitalized With COVID‐19: A Retrospective Multicenter Study in the United States

Pharmacogenomics in the United States Community Pharmacy Setting: The Clopidogrel-CYP2C19 Example

Contact Info

Product

Resources

About