domingo, 13 de marzo de 2016

Preemptive Pharmacogenomic Testing for Precision Medicine: A Comprehensive Analysis of Five Actionable Pharmacogenomic Genes Using Next-Generation ... - PubMed - NCBI

2016 Mar 3. pii: S1525-1578(16)00044-1. doi: 10.1016/j.jmoldx.2016.01.003. [Epub ahead of print]

Preemptive Pharmacogenomic Testing for Precision Medicine: A Comprehensive Analysis of Five Actionable Pharmacogenomic Genes Using Next-Generation DNA Sequencing and a Customized CYP2D6 Genotyping Cascade.

Ji Y1, Skierka JM1, Blommel JH1, Moore BE1, VanCuyk DL1, Bruflat JK1, Peterson LM1, Veldhuizen TL2, Fadra N3, Peterson SE1, Lagerstedt SA1, Train LJ1,Baudhuin LM1, Klee EW4, Ferber MJ5, Bielinski SJ3, Caraballo PJ6, Weinshilboum RM7, Black JL 3rd8.

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Abstract

Significant barriers, such as lack of professional guidelines, specialized training for interpretation of pharmacogenomics (PGx) data, and insufficient evidence to support clinical utility, prevent preemptive PGx testing from being widely clinically implemented. The current study, as a pilot project for the Right Drug, Right Dose, Right Time-Using Genomic Data to Individualize Treatment Protocol, was designed to evaluate the impact of preemptive PGx and to optimize the workflow in the clinic setting. We used an 84-gene next-generation sequencing panel that included SLCO1B1, CYP2C19, CYP2C9, and VKORC1 together with a custom-designed CYP2D6 testing cascade to genotype the 1013 subjects of the Right Drug, Right Dose, Right Time-Using Genomic Data to Individualize Treatment Protocol in laboratories approved by the Clinical Laboratory Improvement Act. Actionable PGx variants were placed in patient's electronic medical records where integrated clinical decision support rules alert providers when a relevant medication is ordered. The fraction of this cohort carrying actionable PGx variant(s) in individual genes ranged from 30% (SLCO1B1) to 79% (CYP2D6). When considering all five genes together, 99% of the subjects carried an actionable PGx variant(s) in at least one gene. Our study provides evidence in favor of preemptive PGx testing by identifying the risk of a variant being present in the population we studied.