Computational Health Informatics Program, Boston Children's Hospital; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Computational Health Informatics Program, Boston Children's Hospital; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Genet Med. 2021 Apr;23(4):782-786. doi: 10.1038/s41436-020-01044-2. Epub 2021 Jan 8.
Pharmacogenomic biomarkers are increasingly listed on medication labels and authoritative guidelines but pharmacogenomic-guided prescribing is not yet common. Our objective was to assess the potential for incorporating knowledge of patients' genomic characteristics into prescribing practices.
We performed a retrospective analysis of claims data for 2,096,971 beneficiaries with pharmacy coverage from a national, commercial health insurance plan between January 2017 and December 2019. Children between 0 and 17 years comprised 21% of the cohort. Adults were age 18 to 64. Medications with actionable pharmacogenomic biomarkers (MAPBs) were identified using public information from the US Food and Drug Administration (FDA), Clinical Pharmacogenomics Implementation Consortium (CPIC), and PharmGKB.
MAPBs were dispensed to 63% of the adults and 29% of the children in the cohort. Most frequently dispensed were ibuprofen, ondansetron, codeine, and oxycodone. Most common were medications with CYP2D6, G6PD, or CYPC19 pharmacogenomic biomarkers. Ten percent of the cohort were codispensed more than one MAPB for at least 30 days.
The number of people who might benefit from pharmacogenomic-guided prescribing is substantial. Future work should address obstacles to integrating genomic data into prescriber workflows, complex factors contributing to the magnitude of benefit, and the clinical availability of reliable on-demand or pre-emptive pharmacogenomic testing.
越来越多的药物基因组生物标志物被列入药物标签和权威指南中，但药物基因组指导下的处方仍不常见。我们的目的是评估将患者基因组特征知识纳入处方实践的潜力。
我们对 2096971 名有药房保险的受益人的索赔数据进行了回顾性分析，这些受益人来自一个全国性的商业健康保险计划，时间范围为 2017 年 1 月至 2019 年 12 月。该队列中，儿童（0 至 17 岁）占 21%。成年人的年龄为 18 至 64 岁。使用美国食品和药物管理局（FDA）、临床药物基因组学实施联盟（CPIC）和 PharmGKB 的公共信息，确定具有可操作药物基因组生物标志物（MAPB）的药物。
MAPB 被开给了队列中 63%的成年人和 29%的儿童。最常开出的药物是布洛芬、昂丹司琼、可待因和羟考酮。最常见的是具有 CYP2D6、G6PD 或 CYPC19 药物基因组生物标志物的药物。10%的队列至少有 30 天同时开出了两种以上的 MAPB。
可能受益于药物基因组指导处方的人数相当多。未来的工作应该解决将基因组数据整合到处方工作流程中的障碍、导致受益程度的复杂因素以及可靠的按需或先发制人药物基因组检测的临床可用性。
