Opportunities for Pharmacogenetic Testing to Guide Dosing of Medications in Youths With Medicaid.
JAMA Netw Open
; 7(2): e2355707, 2024 Feb 05.
Article
em En
| MEDLINE
| ID: mdl-38349656
ABSTRACT
Importance There are an increasing number of medications with a high level of evidence for pharmacogenetic-guided dosing (PGx drugs). Knowledge of the prevalence of dispensings of PGx drugs and their associated genes may allow hospitals and clinical laboratories to determine which pharmacogenetic tests to implement. Objectives:
To investigate the prevalence of outpatient dispensings of PGx drugs among Medicaid-insured youths, determine genes most frequently associated with PGx drug dispenses, and describe characteristics of youths who were dispensed at least 1 PGx drug. Design, Setting, andParticipants:
This serial cross-sectional study includes data from 2011 to 2019 among youths aged 0 to 17 years in the Marketscan Medicaid database. Data were analyzed from August to December 2022. Main Outcomes andMeasures:
PGx drugs were defined as any medication with level A evidence as determined by the Clinical Pharmacogenetics Implementation Consortium (CPIC). The number of unique youths dispensed each PGx drug in each year was determined. PGx drugs were grouped by their associated genes for which there was CPIC level A evidence to guide dosing, and a dispensing rate (No. of PGx drugs/100â¯000 youths) was determined for each group for the year 2019. Demographics were compared between youths dispensed at least 1 PGx drug and those not dispensed any PGx drugs.Results:
The number of Medicaid-insured youths queried ranged by year from 2â¯078â¯683 youths in 2011 to 4â¯641â¯494 youths in 2017, including 4â¯126â¯349 youths (median [IQR] age, 9 [5-13] years; 2â¯129â¯926 males [51.6%]) in 2019. The proportion of Medicaid-insured youths dispensed PGx drugs increased from 289â¯709 youths (13.9%; 95% CI, 13.8%-14.0%) in 2011 to 740â¯072 youths (17.9%; 95% CI, 17.9%-18.0%) in 2019. Genes associated with the most frequently dispensed medications were CYP2C9, CYP2D6, and CYP2C19 (9197.0 drugs [95% CI, 9167.7-9226.3 drugs], 8731.5 drugs [95% CI, 8702.5-8759.5 drugs], and 3426.8 drugs [95% CI, 3408.1-3443.9 drugs] per 100â¯000 youths, respectively). There was a higher percentage of youths with at least 1 chronic medical condition among youths dispensed at least 1 PGx drug (510â¯445 youths [69.0%; 95% CI, 68.8%-69.1%]) than among 3â¯386â¯277 youths dispensed no PGx drug (1â¯381â¯544 youths [40.8%; 95% CI, 40.7%-40.9%) (P < .001) in 2019. Conclusions and Relevance In this study, there was an increasing prevalence of dispensings for PGx drugs. This finding suggests that pharmacogenetic testing of specific drug-gene pairs should be considered for frequently prescribed PGx drugs and their implicated genes.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Medicaid
/
Testes Farmacogenômicos
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article