Physician response to implementation of genotype-tailored antiplatelet therapy.

Peterson JF, Field JR, Unertl KM, Schildcrout JS, Johnson DC, Shi Y, Danciu I, Cleator JH, Pulley JM, McPherson JA, Denny JC, Laposata M, Roden DM, Johnson KB
Clin Pharmacol Ther. 2016 100 (1): 67-74

PMID: 26693963 · PMCID: PMC4899238 · DOI:10.1002/cpt.331

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.

© 2015 American Society for Clinical Pharmacology and Therapeutics.

MeSH Terms (18)

Aged Age Factors Clinical Decision-Making Clopidogrel Cytochrome P-450 CYP2C19 Female Genetic Variation Genotype Humans Male Middle Aged Pharmacogenetics Platelet Aggregation Inhibitors Practice Patterns, Physicians' Precision Medicine Prospective Studies Stents Ticlopidine

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