Physician response to implementation of genotype-tailored antiplatelet therapy

J. F. Peterson, J. R. Field, K. M. Unertl, J. S. Schildcrout, D. C. Johnson, Y. Shi, I. Danciu, J. H. Cleator, J. M. Pulley, J. A. Mcpherson, J. C. Denny, Michael Laposata, D. M. Roden, K. B. Johnson

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

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.

Original languageEnglish (US)
JournalClinical Pharmacology and Therapeutics
DOIs
StateAccepted/In press - 2016
Externally publishedYes

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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    Peterson, J. F., Field, J. R., Unertl, K. M., Schildcrout, J. S., Johnson, D. C., Shi, Y., Danciu, I., Cleator, J. H., Pulley, J. M., Mcpherson, J. A., Denny, J. C., Laposata, M., Roden, D. M., & Johnson, K. B. (Accepted/In press). Physician response to implementation of genotype-tailored antiplatelet therapy. Clinical Pharmacology and Therapeutics. https://doi.org/10.1002/cpt.331