Abstract
Logistics and (cost-)effectiveness of pharmacogenetic (PGx)-testing may be optimized when delivered through a pre-emptive panel-based approach, within a clinical decision support system (CDSS). Here, clinical recommendations are automatically deployed by the CDSS when a drug-gene interaction (DGI) is encountered. However, this requires record of PGx-panel results in the electronic medical record (EMR). Several studies indicate promising clinical utility of panel-based PGx-testing in polypharmacy and psychiatry, but is undetermined in primary care. Therefore, we aim to quantify both the feasibility and the real-world impact of this approach in primary care. Within a prospective pilot study, community pharmacists were provided the opportunity to request a panel of eight pharmacogenes to guide drug dispensing within a CDSS for 200 primary care patients. In this side-study, this cohort was cross-sectionally followed-up after a mean of 2.5-years. PGx-panel results were successfully recorded in 96% and 68% of pharmacist and general practitioner (GP) EMRs, respectively. This enabled 97% of patients to (re)use PGx-panel results for at least one, and 33% for up to four newly initiated prescriptions with possible DGIs. A total of 24.2% of these prescriptions had actionable DGIs, requiring pharmacotherapy adjustment. Healthcare utilization seemed not to vary among those who did and did not encounter a DGI. Pre-emptive panel-based PGx-testing is feasible and real-world impact is substantial in primary care.
Highlights
An individual’s response to a drug can be predicted by their pharmacogenetic (PGx) profile [1,2].Incorporation of an individual’s PGx profile into drug prescribing promises a safer, more effective and thereby more cost-effective drug treatment [3,4]
Pharmacists who agreed on participation were provided with the opportunity to request free PGx tests for a panel of 40 variants in eight pharmacogenes, to guide drug dispensing based on the DutchPharmacogenetics Working Group (DPWG) guidelines, for a maximum of 200 patients
Overall 200 patients were enrolled in the IP3 study between November 2014 and July 2016
Summary
An individual’s response to a drug can be predicted by their pharmacogenetic (PGx) profile [1,2].Incorporation of an individual’s PGx profile into drug prescribing promises a safer, more effective and thereby more cost-effective drug treatment [3,4]. Several randomized controlled trials (RCTs) demonstrate the clinical utility of pre-emptive single gene tests to guide dosing [5,6,7], and drug selection [8], for individual drug-gene interactions. Pharmacogenetics Working Group (DPWG) was established in 2005 to devise clinical guidelines for individual drug-gene interactions based on a systematic review of literature [11,12].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
