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Individualized versus Standardized Risk Assessment in Patients at High Risk for Adverse Drug Reactions (The IDrug Randomized Controlled Trial)-Never Change a Running System? Pharmaceuticals (Basel) 2021; 14:ph14101056. [PMID: 34681280 PMCID: PMC8538435 DOI: 10.3390/ph14101056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to compare effects of an individualized with a standardized risk assessment for adverse drug reactions to improve drug treatment with antithrombotic drugs in older adults. A randomized controlled trial was conducted in general practitioner (GP) offices. Patients aged 60 years and older, multi-morbid, taking antithrombotic drugs and at least one additional drug continuously were randomized to individualized and standardized risk assessment groups. Patients were followed up for nine months. A composite endpoint defined as at least one bleeding, thromboembolic event or death reported via a trigger list was used. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. In total, N = 340 patients were enrolled from 43 GP offices. Patients in the individualized risk assessment group met the composite endpoint more often than in the standardized group (OR 1.63 [95%CI 1.02-2.63]) with multiple adjustments. The OR was higher in patients on phenprocoumon treatment (OR 1.99 [95%CI 1.05-3.76]), and not significant on DOAC treatment (OR 1.52 [95%CI 0.63-3.69]). Pharmacogenenetic variants of CYP2C9, 2C19 and VKORC1 were not observed to be associated with the composite endpoint. The results of this study may indicate that the time point for implementing individualized risk assessments is of importance.
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Just KS, Dormann H, Schurig M, Böhme M, Fracowiak J, Steffens M, Scholl C, Seufferlein T, Gräff I, Schwab M, Stingl JC. Adverse Drug Reactions in the Emergency Department: Is There a Role for Pharmacogenomic Profiles at Risk?-Results from the ADRED Study. J Clin Med 2020; 9:jcm9061801. [PMID: 32527038 PMCID: PMC7355597 DOI: 10.3390/jcm9061801] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 02/08/2023] Open
Abstract
Individual differences in required drug dosages exist based on the pharmacogenomic (PGx) profiles. This study aimed to assess associations between PGx profiles and adverse drug reactions (ADR) that lead to admissions to the emergency department (ED). ADR cases of the prospective multi-center observational trial in EDs (ADRED study) were analyzed (n = 776) together with the relevant PGx phenotypes of the enzymes CYP2D6, CYP2C19, CYP2C9, and VKORC1. Overall, the allele frequency distribution in this cohort did not differ from the population frequencies. We compared the frequencies of phenotypes in the subgroups with the drugs suspected of certain ADR, in the remaining cases. The frequency distribution of CYP2C19 differed for the ADR bleeding cases suspected of clopidogrel (p = 0.020). In a logistic regression analysis, higher CYP2C19 activity (OR (95% CI): 4.97 (1.73−14.27)), together with age (1.05 (1.02−1.08)), showed an impact on the clopidogrel-suspecting ADRs, when adjusting for the clinical parameters. There was a trend for an association of phenprocoumon-risk profiles (low VKORC1 or CYP2C9 activity) with phenprocoumon-suspecting ADRs (p = 0.052). The PGx impact on serious ADRs might be highest in drugs that cannot be easily monitored or those that do not provoke mild ADR symptoms very quickly. Therefore, patients that require the intake of those drugs with PGx variability such as clopidogrel, might benefit from PGx testing.
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Affiliation(s)
- Katja S. Just
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, 52074 Aachen, Germany;
| | - Harald Dormann
- Central Emergency Department, Hospital Fürth, 90766 Fürth, Germany;
| | - Marlen Schurig
- Research Department, Federal Institute for Drugs and Medical Devices, 53175 Bonn, Germany; (M.S.); (M.B.); (J.F.); (M.S.); (C.S.)
| | - Miriam Böhme
- Research Department, Federal Institute for Drugs and Medical Devices, 53175 Bonn, Germany; (M.S.); (M.B.); (J.F.); (M.S.); (C.S.)
| | - Jochen Fracowiak
- Research Department, Federal Institute for Drugs and Medical Devices, 53175 Bonn, Germany; (M.S.); (M.B.); (J.F.); (M.S.); (C.S.)
| | - Michael Steffens
- Research Department, Federal Institute for Drugs and Medical Devices, 53175 Bonn, Germany; (M.S.); (M.B.); (J.F.); (M.S.); (C.S.)
| | - Catharina Scholl
- Research Department, Federal Institute for Drugs and Medical Devices, 53175 Bonn, Germany; (M.S.); (M.B.); (J.F.); (M.S.); (C.S.)
| | - Thomas Seufferlein
- Internal Medicine Emergency Department, Ulm University Medical Centre, 89081 Ulm, Germany;
| | - Ingo Gräff
- Interdisciplinary Emergency Department (INZ), University Hospital of Bonn, 53127 Bonn, Germany;
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany;
- Department of Clinical Pharmacology, University of Tuebingen, 72076 Tuebingen, Germany
- Department of Pharmacy and Biochemistry, University of Tuebingen, 72076 Tuebingen, Germany
| | - Julia C. Stingl
- Institute of Clinical Pharmacology, University Hospital of RWTH Aachen, 52074 Aachen, Germany;
- Correspondence: ; Tel.: +49-241-8089-130
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