Details:

Alternative Title:
Clin Pharmacol Ther
Publisher's site:
http://dx.doi.org/10.1002/cpt.331
Personal Author:
Peterson, Josh F. ; Field, Julie R. ; Unertl, Kim ; Schildcrout, Jonathan S. ; Johnson, Daniel C. ; ... More +
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. ; Less -
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.
Subject:
[+]
Aged
Age Factors
Antiplatelet Therapy
Article
Clinical Decision-Making
CYP2C19
Cytochrome P-450 CYP2C19
Female
Genetic Variation
Genomics
Genotype
Humans
Information Technology
Male
Middle Aged
Pharmacogenetics
Platelet Aggregation Inhibitors
Practice Patterns, Physicians'
Precision Medicine
Prospective Studies
Stents
Ticlopidine

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 ; ... More +
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 ; Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:f6dc750bdd2dd19d117ef8570b4573cbead5c897d7dca48ff55c47c8c5e94118
File Type:

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