Precision pharmacotherapy: Integrating pharmacogenomics into clinical pharmacy practice

Hicks, J. Kevin; Aquilante, Christina L.; Dunnenberger, Henry M.; Gammal, Roseann S.; Funk, Ryan S.; Aitken, Samuel L; Bright, David R.; Coons, James C.; Dotson, Kierra M; Elder, Christopher T; Groff, Lindsey T; Lee, James C.

doi:10.1002/jac5.1118

Cited by 52 publications

(44 citation statements)

References 83 publications

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“…Pharmacists are very well positioned to make major contributions to the field of Precision Medicine given their knowledge and competencies 4,8,38‐49 . It is evidenced by their capability to adequately interpret actionable recommendations derived from PGx‐guided CDS tools and formulate independent clinical judgments, rendering the pharmacist‐provided CMM an ideal niche for PGx‐guided CDS.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, the American Society of Health‐System Pharmacists (ASHP) upheld the pharmacist's role in implementing PGx at clinical settings, which translates into improved outcomes, better drug selection, and increased patient safety 3 . Likewise, the American College of Clinical Pharmacy (ACCP) envisions the clinical pharmacogenomic implementation as an essential component of precision pharmacotherapy 4 . A feasible approach to integrate PGx into pharmacy practice is through Comprehensive Medication Management (CMM) services 5‐7 .…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the clinical utility of pharmacogenetic guidance in a comprehensive medication management service

Rodríguez-Escudero

Cedeño

Rodríguez-Nazario

et al. 2020

J Am Coll Clin Pharm

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Introduction Pharmacists are poised to be the health care professionals best suited to provide medication‐related consults and services based on a patient's genetics. Despite its potential benefits, the implementation of pharmacogenetic (PGx) testing into primary clinical settings has been slow among medically underserved populations. To our knowledge, this is the first time that PGx‐driven recommendations have been incorporated into a Comprehensive Medication Management (CMM) service in a Hispanic population. Objectives The aim of this study is to evaluate the clinical utility of adding PGx guidance into pharmacist‐driven CMM. Methods This is a pre‐ and post‐interventional design study. Patients were recruited from a psychologist's clinic. A total of 24 patients had a face‐to‐face interview with a pharmacist to complete a CMM, Personal Medication Record, and Medication‐Related Action Plan (MAP) blind to PGx findings. Collected buccal DNA samples were genotyped using drug‐metabolizing enzymes and transporters (DMET) Plus Array. Results The pharmacist generated new MAPs for each patient based on PGx results. Genetic variants that could potentially affect the safety and effectiveness of at least one drug in the pharmacotherapy were identified in 96% of patients, for whom the pharmacist changed the initial recommendations. Polymorphisms in genes encoding for isoenzymes CYP2D6, CYP2C19, and CYP2C9 were identified in 83%, 52%, and 41% of patients, respectively. Pharmacists performing CMM identified 22 additional medication problems after PGx determinations. Moreover, they agreed with the clinical utility of PGx in the studied sample based on perceived value of adding PGx to traditional CMM and its utility in the decision‐making process of pharmacists. Conclusions The study confirmed the critical role to be played by pharmacists in facilitating the clinical usage of relevant genetic information to optimize drug therapy decisions as well as their involvement on many levels of these multidisciplinary implementation efforts, including championing and leading PGx‐guided CMM services.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of the clinical utility of pharmacogenetic guidance in a comprehensive medication management service

Rodríguez-Escudero

Cedeño

Rodríguez-Nazario

et al. 2020

J Am Coll Clin Pharm

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“…In terms of relative advantage, PGx initiatives should engage transplant stakeholders early in the process to define evaluation metrics and the value proposition to both providers and patients 44 . These metrics should then be systematically evaluated on a regular basis to understand the overall value of PGx testing in the SOT population 43,44 …”

Section: Discussionmentioning

confidence: 99%

National survey of physicians’ perspectives on pharmacogenetic testing in solid organ transplantation

Deininger

Tsunoda

Hirsch

et al. 2020

Clinical Transplantation

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Introduction Our objective was to evaluate physicians' perspectives on the clinical utility of pharmacogenetic (PGx) testing in kidney, liver, heart, and lung transplantation (KLHL‐Tx). Methods A 36‐question web‐based survey was developed and administered to medical and surgical directors of US KLHL‐Tx centers. Results There were 82 respondents (10% response rate). The majority were men (78%), non‐Hispanic whites (70%), medical directors (72%), and kidney transplant physicians (35%). Although 78% of respondents reported having some PGx education, most reported lack of confidence in their PGx knowledge and ability to apply a PGx test. Participants reported mixed views about the clinical utility of PGx testing—most agreed with the efficacy of PGx testing, but not the benefits relative to the risks or standard of care. While 55% reported that testing was available at their institution, only 38% ordered a PGx test in the past year, most commonly thiopurine‐S‐methyltransferase. Physician‐reported barriers to PGx implementation included uncertainty about the clinical value of PGx testing and patient financial burden. Conclusion Together, our findings suggest prospective PGx research and pilot implementation programs are needed to elucidate the clinical utility and value of PGx in KLHL‐Tx. These initiatives should include educational efforts to inform the use of PGx testing.

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“…The need for clinical pharmacist input in research and implementation efforts has also been recognized by professional societies and other health care providers, allowing pharmacists to further demonstrate their value in the health system. 61,62 Pre-and post-implementations efforts led by pharmacists in a pilot project at the University of Florida assessing genotypeguided antiplatelet therapy found that successful implementation required expertise in pharmacy informatics (for CDS development in the EHR), medication safety, medication-use policies and processes, and educational strategy development. 61 With a deep-rooted background in pharmacology and medication management, pharmacists can build upon their clinical services and help execute PGx efforts as the medical community works toward fully embracing its clinical implementation.…”

Section: Role Of Pharmacistsmentioning

confidence: 99%

“…Advanced PGx training opportunities are now available with the establishment of residencies and fellowships, certificate programs, and continuing education courses. The need for clinical pharmacist input in research and implementation efforts has also been recognized by professional societies and other health care providers, allowing pharmacists to further demonstrate their value in the health system 61,62 . Pre‐ and post‐implementations efforts led by pharmacists in a pilot project at the University of Florida assessing genotype‐guided antiplatelet therapy found that successful implementation required expertise in pharmacy informatics (for CDS development in the EHR), medication safety, medication‐use policies and processes, and educational strategy development 61 .…”

Section: Implementation Of Pharmacogenetics Into Clinical Practicementioning

confidence: 99%

DPYD and UGT1A1 Pharmacogenetic Testing in Patients with Gastrointestinal Malignancies: An Overview of the Evidence and Considerations for Clinical Implementation

et al. 2020

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Gastrointestinal (GI) malignancies are among the most commonly diagnosed cancers worldwide. Despite the introduction of targeted and immunotherapy agents in the treatment landscape, cytotoxic agents, such as fluoropyrimidines and irinotecan, remain as the cornerstone of chemotherapy for many of these tumors. Pharmacogenetics (PGx) is a rapidly evolving field that accounts for interpatient variability in drug metabolism to predict therapeutic response and toxicity. Given the significant incidence of severe treatment-related adverse events associated with cytotoxic agents, utilizing PGx can allow clinicians to better anticipate drug tolerability while minimizing treatment interruptions or delays. In this review, the PGx profiles of drug-gene pairs with potential impact in GI malignancy therapy-DPYD-5-fluorouracil/capecitabine and UGT1A1-irinotecanand the available clinical evidence of their roles in reducing severe adverse events are discussed. Considerations for clinical implementation, such as optimal laboratory workflows, electronic health record integration, and stakeholder engagement, as well as provider education, are addressed. Last, exploratory PGx markers in GI malignancy treatment are described. As the PGx knowledge base rapidly evolves, pharmacists will be vital in leveraging their pharmacology knowledge and clinical skills to implement PGx testing in the clinic.

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Precision pharmacotherapy: Integrating pharmacogenomics into clinical pharmacy practice

Cited by 52 publications

References 83 publications

Assessment of the clinical utility of pharmacogenetic guidance in a comprehensive medication management service

Assessment of the clinical utility of pharmacogenetic guidance in a comprehensive medication management service

National survey of physicians’ perspectives on pharmacogenetic testing in solid organ transplantation

DPYD and UGT1A1 Pharmacogenetic Testing in Patients with Gastrointestinal Malignancies: An Overview of the Evidence and Considerations for Clinical Implementation

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