Optimizing Drug Outcomes Through Pharmacogenetics: A Case for Preemptive Genotyping

TLDR

The potential of genotype‑guided prescribing to improve patient safety is recognized, yet the prevalence of pharmacogenetic opportunities and the scale of preventable adverse events remain unknown. The study evaluated how often 56 pharmacogenetically relevant medications were prescribed among 52,942 patients at Vanderbilt University Medical Center. Approximately 65% of patients received at least one actionable drug, and an estimated 383 adverse events could have been avoided, suggesting that multiplexed preemptive genotyping may be a more efficient and safer alternative to reactive testing. Published in Clinical Pharmacology & Therapeutics, 2012, doi:10.1038/clpt.2012.66.

Abstract

Routine integration of genotype data into drug decision making could improve patient safety, particularly if many relevant genetic variants can be assayed simultaneously before prescribing the target drug. The frequency of opportunities for pharmacogenetic prescribing and the potential adverse events (AEs) mitigated are unknown. We examined the frequency with which 56 medications with known outcomes influenced by variant alleles were prescribed in a cohort of 52,942 medical home patients at Vanderbilt University Medical Center (VUMC). Within a 5-year window, we estimated that 64.8% (95% confidence interval (CI): 64.4–65.2%) of individuals were exposed to at least one medication with an established pharmacogenetic association. Using previously published results for six medications with severe, well-characterized, genetically linked AEs, we estimated that 383 events (95% CI, 212–552) could have been prevented with an effective preemptive genotyping program. Our results suggest that multiplexed, preemptive genotyping may represent an efficient alternative approach to current single-use ("reactive") methods and may also improve safety. Clinical Pharmacology & Therapeutics (2012); 92 2, 235–242. doi:10.1038/clpt.2012.66