Physician Response to Implementation of Genotype-Tailored Antiplatelet Therapy

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.

doi:10.1002/cpt.331

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Physician Response to Implementation of Genotype-Tailored Antiplatelet Therapy

Published Date:

Feb 17 2016

Publisher's site:

http://dx.doi.org/10.1002/cpt.331 New Site Icon

Source:

Clin Pharmacol Ther. 100(1):67-74.

[PDF-255.38 KB]

Details:

Personal Authors:

Peterson, Josh F. ; Field, Julie R. ; Unertl, Kim ; Schildcrout, Jonathan S. ; Johnson, Daniel C. ; ... More ▼

Keywords:

[+]

Pubmed ID:

26693963

Pubmed Central ID:

PMC4899238

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.

Document Type:

Journal Article

Collection(s):

CDC Public Access

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

Supporting Files:

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