Preemptive Clinical Pharmacogenetics Implementation: Current Programs in Five US Medical Centers

• Published in: Annual review of pharmacology and toxicology Vol. 55; no. 1; pp. 89 - 106
• Main Authors: Dunnenberger, Henry M, Crews, Kristine R, Hoffman, James M, Caudle, Kelly E, Broeckel, Ulrich, Howard, Scott C, Hunkler, Robert J, Klein, Teri E, Evans, William E, Relling, Mary V
• Format: Journal Article
• Language: English
• Published: United States Annual Reviews 06-01-2015
• Subjects: Academic Medical Centers - organization & administration; clinical decision support; Decision Support Techniques; Drug-Related Side Effects and Adverse Reactions - genetics; Drug-Related Side Effects and Adverse Reactions - prevention & control; Education, Medical; Genetic Testing; Genotype; Humans; individualized medicine; Models, Organizational; Patient Safety; Patient Selection; personalized medicine; Pharmacogenetics - education; Pharmacogenetics - organization & administration; pharmacogenomics; Pharmacy Service, Hospital - organization & administration; Phenotype; Precision Medicine; prediction in pharmacology; Predictive Value of Tests; Program Development; Program Evaluation; Risk Assessment; Risk Factors; United States; United States; precision medicine; pharmacogenomics; prediction in pharmacology; clinical decision support; individualized medicine; personalized medicine
• ISSN: 0362-1642; 1545-4304
• DOI: 10.1146/annurev-pharmtox-010814-124835

Although the field of pharmacogenetics has existed for decades, practioners have been slow to implement pharmacogenetic testing in clinical care. Numerous publications describe the barriers to clinical implementation of pharmacogenetics. Recently, several freely available resources have been developed to help address these barriers. In this review, we discuss current programs that use preemptive genotyping to optimize the pharmacotherapy of patients. Array-based preemptive testing includes a large number of relevant pharmacogenes that impact multiple high-risk drugs. Using a preemptive approach allows genotyping results to be available prior to any prescribing decision so that genomic variation may be considered as an inherent patient characteristic in the planning of therapy. This review describes the common elements among programs that have implemented preemptive genotyping and highlights key processes for implementation, including clinical decision support.