Physician Response to Implementation of Genotype-Tailored Antiplatelet Therapy

Details

• Alternative Title:
  Clin Pharmacol Ther
• Personal Author:
  Peterson, Josh F. ; Field, Julie R. ; Unertl, Kim ; Schildcrout, Jonathan S. ; Johnson, Daniel C. ; Shi, Yaping ; Danciu, Ioana ; Cleator, John H. ; Pulley, Jill M. ; McPherson, John A. ; Denny, Josh C. ; Laposata, Michael ; Roden, Dan M. ; Johnson, Kevin B.
• Description:
  Physician responses to genomic information are vital to the success of precision medicine initiatives. We prospectively studied a pharmacogenomics implementation program for the propensity of clinicians to select antiplatelet therapy based on CYP2C19 loss-of-function variants in stented patients. Among 2,676 patients, 514 (19.2%) were found to have a CYP2C19 variant affecting clopidogrel metabolism. For the majority (93.6%) of the cohort, cardiologists received active and direct notification of CYP2C19 status. Over 12 months, 57.6% of poor metabolizers and 33.2% of intermediate metabolizers received alternatives to clopidogrel. CYP2C19 variant status was the most influential factor impacting the prescribing decision (hazard ratio [HR] in poor metabolizers 8.1, 95% confidence interval [CI] [5.4, 12.2] and HR 5.0, 95% CI [4.0, 6.3] in intermediate metabolizers), followed by patient age and type of stent implanted. We conclude that cardiologists tailored antiplatelet therapy for a minority of patients with a CYP2C19 variant and considered both genomic and nongenomic risks in their clinical decision-making.
• Subjects:
  Aged Age Factors Clinical Decision-Making Cytochrome P-450 CYP2C19 Female Genetic Variation Genotype Humans Male Middle Aged Pharmacogenetics Platelet Aggregation Inhibitors Practice Patterns, Physicians' Precision Medicine Prospective Studies Stents Ticlopidine

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• Source:
  Clin Pharmacol Ther. 100(1):67-74.
• Pubmed ID:
  26693963
• Pubmed Central ID:
  PMC4899238
• Document Type:
  Journal Article
• Funding:
  U01 HL105198/HL/NHLBI NIH HHS/United States ; U01 HG007253/HG/NHGRI NIH HHS/United States ; UL1 TR000445/TR/NCATS NIH HHS/United States ; U01 HL122904/HL/NHLBI NIH HHS/United States ; U19 HL065962/HL/NHLBI NIH HHS/United States ; U47 CI000824/CI/NCPDCID CDC HHS/United States ; U01 HG008672/HG/NHGRI NIH HHS/United States ; U01 HG006378/HG/NHGRI NIH HHS/United States
• Volume:
  100
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f6dc750bdd2dd19d117ef8570b4573cbead5c897d7dca48ff55c47c8c5e94118
• Download URL:
  https://stacks.cdc.gov/view/cdc/39853/cdc_39853_DS1.pdf
• File Type:
  [PDF - 255.38 KB ]