Clinician adherence to pharmacogenomics prescribing recommendations in clinical decision support alerts

Posted on by Alexis

Jenny Q Nguyen, Kristine R Crews, Ben T Moore, Nancy M Kornegay, Donald K Baker, Murad Hasan, Patrick K Campbell, Shannon M Dean, Mary V Relling , James M Hoffman, Cyrine E Haidar

Abstract

Thoughtful integration of interruptive clinical decision support (CDS) alerts within the electronic health record is essential to guide clinicians on the application of pharmacogenomic results at point of care. St. Jude Children’s Research Hospital implemented a preemptive pharmacogenomic testing program in 2011 in a multidisciplinary effort involving extensive education to clinicians about pharmacogenomic implications. We conducted a retrospective analysis of clinicians’ adherence to 4783 pharmacogenomically guided CDS alerts that triggered for 12 genes and 60 drugs. Clinicians adhered to the therapeutic recommendations provided in 4392 alerts (92%). In our population of pediatric patients with catastrophic illnesses, the most frequently presented gene/drug CDS alerts were TPMT/NUDT15 and thiopurines (n = 3850), CYP2D6 and ondansetron (n = 667), CYP2D6 and oxycodone (n = 99), G6PD and G6PD high-risk medications (n = 51), and CYP2C19 and proton pump inhibitors (omeprazole and pantoprazole; n = 50). The high adherence rate was facilitated by our team approach to prescribing and our collaborative CDS design and delivery.

Keywords: clinical decision support; medication alert systems; pharmacogenetics; pharmacogenomics; precision medicine.

The Promise and Challenges of Implementing Pharmacogenomics to Improve Population Health

Thursday, September 14 | 12-1 p.m. ET | Online

CDC Webinar: The Promise and Challenges of Implementing Pharmacogenomics to Improve Population Health: Where Are we Heading with Preemptive Pharmacogenomic Screening?

Individual variability in drug response efficacy or safety is becoming an increasing problem globally, given the growing population of older adults. Reasons for this variability include genomic factors, an area of study called pharmacogenomics. With genotyping technologies now widely available and decreasing in cost, implementing pharmacogenomics into clinical practice is widely viewed as an initial step in mainstreaming genomic medicine.

This seminar will review recent developments in the field of pharmacogenomics and the ongoing challenges in equitable translation of discoveries into clinical practice and public health programs.

Speaker:

Professor Sir Munir Pirmohamed, MB ChB (Hons), PhD, FRCP, FRCP(E), FFPM, FRSB, FBPhS, FMedSci
David Weatherall Chair of Medicine and National Health Service Chair of Pharmacogenetics
Director, Centre for Drug Safety Science and Wolfson Centre for Personalised Medicine
Institute of Systems, Molecular and Integrative Biology (ISMIB)
University of Liverpool

Please note: registration is required. Visit the CDC Genomics & Precision Health event page to learn more and sign up.

Evidence Regarding Pharmacogenetics in Pain Management and Cancer

Posted on by Alexis

D Max Smith, William D Figg

Abstract

Patients experience interindividual variation in response to analgesics, which may be partially explained by genetics. This commentary discusses a recently published trial on COMT genotype and opioid dose requirements and describes the potential role for COMT and other genes (eg, CYP2D6) on opioid therapy and the current evidence for germline pharmacogenetics and resources for opioid pharmacogenetics.

Keywords: cancer pain; opioids; pain; pharmacogenetics; pharmacogenomics. 

PGx ECHO

Friday, July 21 | 1-2 pm ET (12-1 pm CT) | Online

The University of Minnesota College of Pharmacy invites all actively practicing clinicians to join their Pharmacogenomics (PGx) ECHO project. PGx ECHO aims to improve health professionals’ confidence in using PGx in patient care by providing case-based education and consultation through telementoring. Every month, clinicians from across the nation seek PGx advice regarding real clinical cases. PGx ECHO is modeled on the all-teach-all-learn principle and encourages interactive and engaging discussion between attendees and facilitators.

The University of Minnesota works with colleagues at Children’s MN, Ferris State University, M Health Fairview, Manchester University, North Dakota State University, South Dakota State University, and Sanford Health to coordinate and facilitate the monthly sessions. PGx ECHO meets the third Friday of every month over the lunch hour. For past ECHO cases and topics, and a schedule of upcoming cases, please visit the PGx ECHO website.

If you are interested in joining, please use this link to register.

PGx ECHO is for practicing clinicians with direct patient care responsibilities. Student learners are welcome to join.

If you would like to present a case or have any questions, please contact pgxecho@umn.edu.

PGx ECHO

Friday, June 16 | 1-2 pm ET (12-1 pm CT) | Online

The University of Minnesota College of Pharmacy invites all actively practicing clinicians to join their Pharmacogenomics (PGx) ECHO project. PGx ECHO aims to improve health professionals’ confidence in using PGx in patient care by providing case-based education and consultation through telementoring. Every month, clinicians from across the nation seek PGx advice regarding real clinical cases. PGx ECHO is modeled on the all-teach-all-learn principle and encourages interactive and engaging discussion between attendees and facilitators.

The University of Minnesota works with colleagues at Children’s MN, Ferris State University, M Health Fairview, Manchester University, North Dakota State University, South Dakota State University, and Sanford Health to coordinate and facilitate the monthly sessions. PGx ECHO meets the third Friday of every month over the lunch hour. For past ECHO cases and topics, and a schedule of upcoming cases, please visit the PGx ECHO website.

If you are interested in joining, please use this link to register.

PGx ECHO is for practicing clinicians with direct patient care responsibilities. Student learners are welcome to join.

If you would like to present a case or have any questions, please contact pgxecho@umn.edu.

PGx ECHO

Friday, May 19 | 1-2 pm ET (12-1 pm CT) | Online

The University of Minnesota College of Pharmacy invites all actively practicing clinicians to join their Pharmacogenomics (PGx) ECHO project. PGx ECHO aims to improve health professionals’ confidence in using PGx in patient care by providing case-based education and consultation through telementoring. Every month, clinicians from across the nation seek PGx advice regarding real clinical cases. PGx ECHO is modeled on the all-teach-all-learn principle and encourages interactive and engaging discussion between attendees and facilitators.

The University of Minnesota works with colleagues at Children’s MN, Ferris State University, M Health Fairview, Manchester University, North Dakota State University, South Dakota State University, and Sanford Health to coordinate and facilitate the monthly sessions. PGx ECHO meets the third Friday of every month over the lunch hour. For past ECHO cases and topics, and a schedule of upcoming cases, please visit the PGx ECHO website.

If you are interested in joining, please use this link to register.

PGx ECHO is for practicing clinicians with direct patient care responsibilities. Student learners are welcome to join.

If you would like to present a case or have any questions, please contact pgxecho@umn.edu.

PGx ECHO

Friday, April 21 | 1-2 pm ET (12-1 pm CT) | Online

The University of Minnesota College of Pharmacy invites all actively practicing clinicians to join their Pharmacogenomics (PGx) ECHO project. PGx ECHO aims to improve health professionals’ confidence in using PGx in patient care by providing case-based education and consultation through telementoring. Every month, clinicians from across the nation seek PGx advice regarding real clinical cases. PGx ECHO is modeled on the all-teach-all-learn principle and encourages interactive and engaging discussion between attendees and facilitators.

The University of Minnesota works with colleagues at Children’s MN, Ferris State University, M Health Fairview, Manchester University, North Dakota State University, South Dakota State University, and Sanford Health to coordinate and facilitate the monthly sessions. PGx ECHO meets the third Friday of every month over the lunch hour. For past ECHO cases and topics, and a schedule of upcoming cases, please visit the PGx ECHO website.

If you are interested in joining, please use this link to register.

PGx ECHO is for practicing clinicians with direct patient care responsibilities. Student learners are welcome to join.

If you would like to present a case or have any questions, please contact pgxecho@umn.edu.

PGx ECHO

Friday, March 17 | 1-2 pm ET (12-1 pm CT) | Online

The University of Minnesota College of Pharmacy invites all actively practicing clinicians to join their Pharmacogenomics (PGx) ECHO project. PGx ECHO aims to improve health professionals’ confidence in using PGx in patient care by providing case-based education and consultation through telementoring. Every month, clinicians from across the nation seek PGx advice regarding real clinical cases. PGx ECHO is modeled on the all-teach-all-learn principle and encourages interactive and engaging discussion between attendees and facilitators.

The University of Minnesota works with colleagues at Children’s MN, Ferris State University, M Health Fairview, Manchester University, North Dakota State University, South Dakota State University, and Sanford Health to coordinate and facilitate the monthly sessions. PGx ECHO meets the third Friday of every month over the lunch hour. For past ECHO cases and topics, and a schedule of upcoming cases, please visit the PGx ECHO website.

If you are interested in joining, please use this link to register.

PGx ECHO is for practicing clinicians with direct patient care responsibilities. Student learners are welcome to join.

If you would like to present a case or have any questions, please contact pgxecho@umn.edu.

Pharmacogenetics of Antiplatelet Therapy

Posted on by Alexis

Matteo Castrichini, Jasmine A Luzum, Naveen Pereira

Abstract

Antiplatelet therapy is used in the treatment of patients with acute coronary syndromes, stroke, and those undergoing percutaneous coronary intervention. Clopidogrel is the most widely used antiplatelet P2Y12 inhibitor in clinical practice. Genetic variation in CYP2C19 may influence its enzymatic activity, resulting in individuals who are carriers of loss-of-function CYP2C19 alleles and thus have reduced active clopidogrel metabolites, high on-treatment platelet reactivity, and increased ischemic risk. Prospective studies have examined the utility of CYP2C19 genetic testing to guide antiplatelet therapy, and more recently published meta-analyses suggest that pharmacogenetics represents a key treatment strategy to individualize antiplatelet therapy. Rapid genetic tests, including bedside genotyping platforms that are validated and have high reproducibility, are available to guide selection of P2Y12 inhibitors in clinical practice. The aim of this review is to provide an overview of the background and rationale for the role of a guided antiplatelet approach to enhance patient care.

Keywords: CYP2C19; dual antiplatelet therapy; guided antiplatelet therapy; pharmacogenetics; pharmacogenomics; precision medicine.

PGx ECHO

Friday, February 17 | 1-2 pm ET (12-1 pm CT) | Virtual

The University of Minnesota College of Pharmacy invites all actively practicing clinicians to join their Pharmacogenomics (PGx) ECHO project. PGx ECHO aims to improve health professionals’ confidence in using PGx in patient care by providing case-based education and consultation through telementoring. Every month, clinicians from across the nation seek PGx advice regarding real clinical cases. PGx ECHO is modeled on the all-teach-all-learn principle and encourages interactive and engaging discussion between attendees and facilitators.

The University of Minnesota works with colleagues at Children’s MN, Ferris State University, M Health Fairview, Manchester University, North Dakota State University, South Dakota State University, and Sanford Health to coordinate and facilitate the monthly sessions. PGx ECHO meets the third Friday of every month over the lunch hour. For past ECHO cases and topics, and a schedule of upcoming cases, please visit the PGx ECHO website.

If you are interested in joining, please use this link to register.

PGx ECHO is for practicing clinicians with direct patient care responsibilities. Student learners are welcome to join.

If you would like to present a case or have any questions, please contact pgxecho@umn.edu.