ABSTRACT
Aim: Clopidogrel requires CYP2C19 activation to have antiplatelet effects. Pharmacogenetic testing to identify patients with impaired CYP2C19 function can be coupled with clinical decision support (CDS) alerts to guide antiplatelet prescribing. We evaluated the impact of alerts on clopidogrel prescribing.Materials & methods: We retrospectively analyzed data for 866 patients in which CYP2C19-clopidogrel CDS was deployed at a single healthcare system during 2015-2023.Results: Analyses included 2,288 alerts. CDS acceptance rates increased from 24% in 2015 to 63% in 2023 (p < 0.05). Adjusted analyses also showed higher acceptance rates when clopidogrel had been ordered for a percutaneous intervention (OR: 28.7, p < 0.001) and when cardiologists responded to alerts (OR: 2.11, p = 0.001).Conclusion: CDS for CYP2C19-clopidogrel was effective in reducing potential drug-gene interactions. Its influence varied by clinician specialty and medication indications.
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Subject(s)
Clopidogrel , Cytochrome P-450 CYP2C19 , Decision Support Systems, Clinical , Platelet Aggregation Inhibitors , Clopidogrel/therapeutic use , Humans , Cytochrome P-450 CYP2C19/genetics , Platelet Aggregation Inhibitors/therapeutic use , Female , Male , Middle Aged , Retrospective Studies , Aged , Pharmacogenetics/methods , Pharmacogenomic Testing/methods , Drug Interactions/geneticsABSTRACT
Background: Statins are commonly used medications. Variants in SLCO1B1, CYP2C9, and ABCG2 are known predictors of muscle effects when taking statins. More exploratory genes include RYR1 and CACNA1S, which can also be associated with disease conditions. Methods: Patients with pathogenic/likely pathogenic variants in RYR1 or CACNA1S were identified through an elective genomic testing program. Through chart review, patients with a history of statin use were assessed for statin-associated muscle symptoms (SAMS) along with collection of demographics and other known risk factors for SAMS. Results: Of the 23 patients who had a pathogenic or likely pathogenic RYR1 or CACNA1S variant found, 12 had previous statin use; of these, SAMS were identified in four patients. Conclusion: These data contribute to previous literature suggesting patients with RYR1 variants may have an increased SAMS risk. Additional research will be helpful in further investigating this relationship and providing recommendations.
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Subject(s)
Calcium Channels, L-Type , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Ryanodine Receptor Calcium Release Channel , Humans , Ryanodine Receptor Calcium Release Channel/genetics , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Male , Calcium Channels, L-Type/genetics , Female , Middle Aged , Aged , Incidence , Muscular Diseases/genetics , Muscular Diseases/chemically induced , Adult , Risk Factors , Calcium Channels/geneticsABSTRACT
Aim: To understand how attitudes toward pharmacogenomic (PGx) testing among healthcare providers varies by specialty. Methods: Providers reported comfort ordering PGx testing and its perceived utility on web-based surveys before and after genetics education. Primary quantitative analyses compared primary care providers (PCPs) to specialty providers at both timepoints. Results: PCPs were more likely than specialty care providers to rate PGx testing as useful at both timepoints. Education increased comfort ordering PGx tests, with larger improvements among PCPs than specialty providers. Over 90% of cardiology and internal medicine providers rated PGx testing as useful at pre- and post-education. Conclusion: PCPs overwhelmingly perceive PGx to be useful, and provider education is particularly effective for improving PCPs' confidence. Education for all specialties will be essential to ensure appropriate integration into routine practice.
Subject(s)
Attitude , Pharmacogenomic Testing , Humans , Delivery of Health Care , Pharmacogenetics , Health PersonnelABSTRACT
Background: Returning pharmacogenomics (PGx) results to patients is complex and challenging. Patients prefer provider education; however, a gap in provider comfort in PGx results has been documented. Objectives: This study's purpose was to evaluate satisfaction with the return of PGx test results using a patient portal message. Methods: A survey was sent to two cohorts with PGx results, one that received a PGx result message and one that did not. Results: Following implementation of the PGx result message, there was a decrease in patients reporting negative responses surrounding satisfaction in the return of their PGx results, with 39% responding negatively pre-implementation and 21% post-implementation. Conclusion: Satisfaction with the return of results improved following the implementation of a patient portal message.
Subject(s)
Patient Portals , Pharmacogenetics , Humans , Patient SatisfactionABSTRACT
Pharmacogenomics (PGx) testing is commonly utilized to predict a patient's response to medications based on the presence of genetic variants. However, certain conditions have been associated with potentially inaccurate PGx results. The majority of medications are predominantly metabolized in the liver; therefore, in the case of liver transplantation, PGx results may be misinterpreted in the context of drug-metabolizing enzymes. Other instances of ambiguous PGx results have been reported in the literature in conditions such as allogeneic stem cell or bone marrow transplant, chronic lymphocytic leukemia, acute or chronic myeloid leukemia and blood transfusion. In order to prevent potential inaccuracies in PGx testing, Sanford Imagenetics developed an active, interruptive alert to inform providers of the potential for inaccurate PGx results.
Subject(s)
Decision Support Systems, Clinical , Hematopoietic Stem Cell Transplantation , Leukemia, Lymphocytic, Chronic, B-Cell , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Humans , PharmacogeneticsABSTRACT
Background: Statins are among the most commonly prescribed medications, and improve patient outcomes by lowering cholesterol levels, but also have side effects. Variations in statin response can be attributed to a handful of factors that include pharmacogenetics. Methods: While not a true review article, this work was written using various search engines and terms and previous and newly published Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for statins to provide a historical perspective in addition to the current status of statin-related pharmacogenetics and future perspectives. Results: This article provides historical background on statins and associated adverse effects, reviews pharmacogenetic implications, applies clinical decision support, incorporates the latest CPIC guidelines and addresses future implications. Conclusion: Statins are a beneficial medication, but not without risk. Pharmacogenomics can help mitigate some risk factors. Clinical decision support, implementation, research and guidelines will continue to influence statin prescribing.