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Physician response to implementation of genotype-tailored antiplatelet therapy

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. Am...

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Bibliographic Details
Published in:Clinical pharmacology and therapeutics 2016-07, Vol.100 (1), p.67-74
Main Authors: 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
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Language:English
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Summary: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.
ISSN:0009-9236
1532-6535
DOI:10.1002/cpt.331