Veterans Health Administration: Implementation of pharmacogenomic clinical decision support with statin medications and the SLCO1B1 gene as an exemplar

Abstract Purpose To describe the implementation of clinical decision support tools for alerting prescribers of actionable drug-gene interactions in the Veterans Health Administration (VHA). Summary Drug-gene interactions have been the focus of clinicians for years. Interactions between SCLO1B1 genot...

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Bibliographic Details
Published in:	American journal of health-system pharmacy Vol. 80; no. 16; pp. 1082 - 1089
Main Authors:	Tomcsanyi, Kelly M, Tran, Kelvin A, Bates, Jill, Cunningham, Francesca E, Silverman, Robert, Norris, Amy K, Moore, Von R, Voora, Deepak
Format:	Journal Article
Language:	English
Published:	US Oxford University Press 04-08-2023
Subjects:	Decision Support Systems, Clinical Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects Pharmacogenetics Precision Medicine Veterans Health veterans pharmacogenomics statin clinical decision support myopathy gene SLCO1B1 gene
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Summary:	Abstract Purpose To describe the implementation of clinical decision support tools for alerting prescribers of actionable drug-gene interactions in the Veterans Health Administration (VHA). Summary Drug-gene interactions have been the focus of clinicians for years. Interactions between SCLO1B1 genotype and statin medications are of particular interest as these can inform risk for statin-associated muscle symptoms (SAMS). VHA identified approximately 500,000 new users of statin medications prescribed in VHA in fiscal year 2021, some of whom could benefit from pharmacogenomic testing for the SCLO1B1 gene. In 2019, VHA implemented the Pharmacogenomic Testing for Veterans (PHASER) program to offer panel-based, preemptive pharmacogenomic testing and interpretation. The PHASER panel includes SLCO1B1, and VHA utilized Clinical Pharmacogenomics Implementation Consortium statin guidelines to build its clinical decision support tools. The program’s overarching goal is to reduce the risk of adverse drug reactions such as SAMS and improve medication efficacy by alerting practitioners of actionable drug-gene interactions. We describe the development and implementation of decision support for the SLCO1B1 gene as an example of the approach being used for the nearly 40 drug-gene interactions screened for by the panel. Conclusion The VHA PHASER program identifies and addresses drug-gene interactions as an application of precision medicine to reduce veterans’ risks for adverse events. The PHASER program’s implementation of statin pharmacogenomics utilizes a patient’s SCLO1B1 phenotype to alert providers of the risk for SAMS with the statin being prescribed and how to lower that risk through a lower dose or alternative statin selection. The PHASER program may help reduce the number of veterans who experience SAMS and may improve their adherence to statin medications.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1079-2082 1535-2900
DOI:	10.1093/ajhp/zxad111