Applicability of Pharmacogenomically Guided Medication Treatment during Hospitalization of At-Risk Minority Patients.

Loren Saulsberry,James C Lee,Anish Choksi,Merisa Middlestadt,Luke V Rasmussen,Kevin J O’Leary,Peter H O’Donnell,Paula N Friedman,Larry House,Thomas Chen,Mark J Ratain,Gregory W Ruhnke,Edith A Nutescu,Keith Danahey,David O Meltzer,Donna L George ,Xander M R Van Wijk ,Randall W Knoebel ,Kiang-Teck J Yeo ,Seth Hartman ,Minoli Perera

doi:10.3390/jpm11121343

Abstract

Known disparities exist in the availability of pharmacogenomic information for minority populations, amplifying uncertainty around clinical utility for these groups. We conducted a multi-site inpatient pharmacogenomic implementation program among self-identified African-Americans (AA; n = 135) with numerous rehospitalizations (n = 341) from 2017 to 2020 (NIH-funded ACCOuNT project/clinicaltrials.gov#NCT03225820). We evaluated the point-of-care availability of patient pharmacogenomic results to healthcare providers via an electronic clinical decision support tool. Among newly added medications during hospitalizations and at discharge, we examined the most frequently utilized medications with associated pharmacogenomic results. The population was predominantly female (61%) with a mean age of 53 years (range 19–86). On average, six medications were newly prescribed during each individual hospital admission. For 48% of all hospitalizations, clinical pharmacogenomic information was applicable to at least one newly prescribed medication. Most results indicated genomic favorability, although nearly 29% of newly prescribed medications indicated increased genomic caution (increase in toxicity risk/suboptimal response). More than one of every five medications prescribed to AA patients at hospital discharge were associated with cautionary pharmacogenomic results (most commonly pantoprazole/suboptimal antacid effect). Notably, high-risk pharmacogenomic results (genomic contraindication) were exceedingly rare. We conclude that the applicability of pharmacogenomic information during hospitalizations for vulnerable populations at-risk for experiencing health disparities is substantial and warrants continued prospective investigation.

Highlights

Prescription drugs lead to a number of serious, harmful side effects, including death.Genetic variation may contribute to inter-individual differences in adverse reactions and efficacy for many [1,2,3]
On average, received approximately one new medication per admission that was associated with cautionary pharmacogenomic information
We found no association between cautionary pharmacogenomic results for newly prescribed medications and frequency of rehospitalization

Summary

Introduction

Prescription drugs lead to a number of serious, harmful side effects, including death.Genetic variation may contribute to inter-individual differences in adverse reactions and efficacy for many [1,2,3]. Guidelines developed based primarily on genetic variation in groups of European descent may be significantly less useful in guiding care delivered to minorities At worst, such guidelines dominantly based on European ancestry populations may be incorrect and could potentially introduce harm with inappropriate pharmacogenomic advice (e.g., false assurances a medication will work or failing to indicate appropriate risk for adverse events). Lack of representation of diverse populations in pharmacogenomics research has exacerbated uncertainty around its clinical utility for minority patients and threatens their equitable realization of the potential health benefits Amidst concerns that this underrepresentation may contribute to well-documented health disparities throughout the healthcare system [4], pharmacogenomics is increasingly being considered in clinical practice and is being advocated for greater use as a step toward precision medicine [5]

Methods

Results

Conclusion