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. 2012 Aug;92(2):235-42.
doi: 10.1038/clpt.2012.66. Epub 2012 Jun 27.

Optimizing drug outcomes through pharmacogenetics: a case for preemptive genotyping

J S Schildcrout  1 , J C Denny, E Bowton, W Gregg, J M Pulley, M A Basford, J D Cowan, H Xu, A H Ramirez, D C Crawford, M D Ritchie, J F Peterson, D R Masys, R A Wilke, D M Roden
Affiliations

Optimizing drug outcomes through pharmacogenetics: a case for preemptive genotyping

J S Schildcrout et al. Clin Pharmacol Ther. 2012 Aug.

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.

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Conflict of interest statement

Conflicts of interest

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Cumulative incidence of medication exposures as a function of time since medical home was established.
See this image and copyright information in PMC

Comment in

  • Doubt about the feasibility of preemptive genotyping.
    Koch BC, van Schaik RH, van Gelder T, Mathijssen RH; Rotterdam Clinical Pharmacology-Pharmacogenetics Group (RCPPG). Koch BC, et al. Clin Pharmacol Ther. 2013 Mar;93(3):233. doi: 10.1038/clpt.2012.191. Epub 2012 Dec 12. Clin Pharmacol Ther. 2013. PMID: 23232547 No abstract available.
  • Response to "Doubt about the feasibility of preemptive genotyping".
    Denny JC, Schildcrout JS, Pulley JM, Roden DM. Denny JC, et al. Clin Pharmacol Ther. 2013 Mar;93(3):234. doi: 10.1038/clpt.2012.223. Epub 2012 Nov 7. Clin Pharmacol Ther. 2013. PMID: 23249779 No abstract available.

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