1
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Gammal RS, Pirmohamed M, Somogyi AA, Morris SA, Formea CM, Elchynski AL, Oshikoya KA, McLeod HL, Haidar CE, Whirl-Carrillo M, Klein TE, Caudle KE, Relling MV. Expanded Clinical Pharmacogenetics Implementation Consortium Guideline for Medication Use in the Context of G6PD Genotype. Clin Pharmacol Ther 2023; 113:973-985. [PMID: 36049896 PMCID: PMC10281211 DOI: 10.1002/cpt.2735] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is associated with development of acute hemolytic anemia in the setting of oxidative stress, which can be caused by medication exposure. Regulatory agencies worldwide warn against the use of certain medications in persons with G6PD deficiency, but in many cases, this information is conflicting, and the clinical evidence is sparse. This guideline provides information on using G6PD genotype as part of the diagnosis of G6PD deficiency and classifies medications that have been previously implicated as unsafe in individuals with G6PD deficiency by one or more sources. We classify these medications as high, medium, or low to no risk based on a systematic review of the published evidence of the gene-drug associations and regulatory warnings. In patients with G6PD deficiency, high-risk medications should be avoided, medium-risk medications should be used with caution, and low-to-no risk medications can be used with standard precautions, without regard to G6PD phenotype. This new document replaces the prior Clinical Pharmacogenetics Implementation Consortium guideline for rasburicase therapy in the context of G6PD genotype (updates at: www.cpicpgx.org).
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Affiliation(s)
- Roseann S. Gammal
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Munir Pirmohamed
- MRC Centre for Drug Safety Science, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Andrew A. Somogyi
- Discipline of Pharmacology, School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Sarah A. Morris
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Cancer Pharmacology and Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Christine M. Formea
- Department of Pharmacy and Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Kazeem A. Oshikoya
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, Lagos State University, Ikeja, Lagos, Nigeria
| | - Howard L. McLeod
- Intermountain Precision Genomics, Intermountain Healthcare, St George, UT, USA
| | - Cyrine E. Haidar
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Teri E. Klein
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Kelly E. Caudle
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Mary V. Relling
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
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2
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Marrs JC, Formea CM, Abdalla M, Brual RL, Crowe SJ, Freibert KH, Herink MC, Hoffman AR, Philbrick AM, Prescott GM, Shahdoost Moghadam S, Zhou C. Call to action: Clinical pharmacist roles and opportunities in health disparities research. J Am Coll Clin Pharm 2023. [DOI: 10.1002/jac5.1764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Joel C. Marrs
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | - Maha Abdalla
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | | | | | | | | | | | - Crystal Zhou
- American College of Clinical Pharmacy Lenexa Kansas USA
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3
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Walton NA, Hafen B, Graceffo S, Sutherland N, Emmerson M, Palmquist R, Formea CM, Purcell M, Heale B, Brown MA, Danford CJ, Rachamadugu SI, Person TN, Shortt KA, Christensen GB, Evans JM, Raghunath S, Johnson CP, Knight S, Le VT, Anderson JL, Van Meter M, Reading T, Haslem DS, Hansen IC, Batcher B, Barker T, Sheffield TJ, Yandava B, Taylor DP, Ranade-Kharkar P, Giauque CC, Eyring KR, Breinholt JW, Miller MR, Carter PR, Gillman JL, Gunn AW, Knowlton KU, Bonkowsky JL, Stefansson K, Nadauld LD, McLeod HL. The Development of an Infrastructure to Facilitate the Use of Whole Genome Sequencing for Population Health. J Pers Med 2022; 12:jpm12111867. [PMID: 36579594 PMCID: PMC9693138 DOI: 10.3390/jpm12111867] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
The clinical use of genomic analysis has expanded rapidly resulting in an increased availability and utility of genomic information in clinical care. We have developed an infrastructure utilizing informatics tools and clinical processes to facilitate the use of whole genome sequencing data for population health management across the healthcare system. Our resulting framework scaled well to multiple clinical domains in both pediatric and adult care, although there were domain specific challenges that arose. Our infrastructure was complementary to existing clinical processes and well-received by care providers and patients. Informatics solutions were critical to the successful deployment and scaling of this program. Implementation of genomics at the scale of population health utilizes complicated technologies and processes that for many health systems are not supported by current information systems or in existing clinical workflows. To scale such a system requires a substantial clinical framework backed by informatics tools to facilitate the flow and management of data. Our work represents an early model that has been successful in scaling to 29 different genes with associated genetic conditions in four clinical domains. Work is ongoing to optimize informatics tools; and to identify best practices for translation to smaller healthcare systems.
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Affiliation(s)
- Nephi A. Walton
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
- Correspondence:
| | - Brent Hafen
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Sara Graceffo
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Nykole Sutherland
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Melanie Emmerson
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Rachel Palmquist
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
- Center for Personalized Medicine, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT 84113, USA
| | - Christine M. Formea
- Department of Pharmacy, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Maricel Purcell
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Bret Heale
- Humanized Health Consulting, Salt Lake City, UT 84102, USA
| | | | | | - Sumathi I. Rachamadugu
- Department of Bioinformatics and Genomics, Pennsylvania State University, University Park, PA 16802, USA
| | - Thomas N. Person
- John Hopkins Genomics—DNA Diagnostics Laboratory, Department of Genetic Medicine, John Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | | | - G. Bryce Christensen
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Jared M. Evans
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Sharanya Raghunath
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Christopher P. Johnson
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Stacey Knight
- Department of Cardiology, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Viet T. Le
- Department of Cardiology, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Jeffrey L. Anderson
- Department of Cardiology, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Margaret Van Meter
- Department of Medical Oncology, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Teresa Reading
- Department of Surgery, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Derrick S. Haslem
- Department of Cardiology, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Ivy C. Hansen
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Betsey Batcher
- Department of Endocrinology, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Tyler Barker
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Travis J. Sheffield
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Bhaskara Yandava
- Digital Technology Services, Intermountain Healthcare, Salt Lake City, UT 84130, USA
| | - David P. Taylor
- Digital Technology Services, Intermountain Healthcare, Salt Lake City, UT 84130, USA
| | | | - Christopher C. Giauque
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Kenneth R. Eyring
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Jesse W. Breinholt
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Mickey R. Miller
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Payton R. Carter
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Jason L. Gillman
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Andrew W. Gunn
- Center for Personalized Medicine, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT 84113, USA
| | - Kirk U. Knowlton
- Department of Cardiology, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Joshua L. Bonkowsky
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
- Center for Personalized Medicine, Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT 84113, USA
| | | | - Lincoln D. Nadauld
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
| | - Howard L. McLeod
- Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT 84107, USA
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4
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Salloum RG, Bishop JR, Elchynski AL, Smith DM, Rowe E, Blake KV, Limdi NA, Aquilante CL, Bates J, Beitelshees AL, Cipriani A, Duong BQ, Empey PE, Formea CM, Hicks JK, Mroz P, Oslin D, Pasternak AL, Petry N, Ramsey LB, Schlichte A, Swain SM, Ward KM, Wiisanen K, Skaar TC, Van Driest SL, Cavallari LH, Tuteja S. Best-worst scaling methodology to evaluate constructs of the Consolidated Framework for Implementation Research: application to the implementation of pharmacogenetic testing for antidepressant therapy. Implement Sci Commun 2022; 3:52. [PMID: 35568931 PMCID: PMC9107643 DOI: 10.1186/s43058-022-00300-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the increased demand for pharmacogenetic (PGx) testing to guide antidepressant use, little is known about how to implement testing in clinical practice. Best–worst scaling (BWS) is a stated preferences technique for determining the relative importance of alternative scenarios and is increasingly being used as a healthcare assessment tool, with potential applications in implementation research. We conducted a BWS experiment to evaluate the relative importance of implementation factors for PGx testing to guide antidepressant use. Methods We surveyed 17 healthcare organizations that either had implemented or were in the process of implementing PGx testing for antidepressants. The survey included a BWS experiment to evaluate the relative importance of Consolidated Framework for Implementation Research (CFIR) constructs from the perspective of implementing sites. Results Participating sites varied on their PGx testing platform and methods for returning recommendations to providers and patients, but they were consistent in ranking several CFIR constructs as most important for implementation: patient needs/resources, leadership engagement, intervention knowledge/beliefs, evidence strength and quality, and identification of champions. Conclusions This study demonstrates the feasibility of using choice experiments to systematically evaluate the relative importance of implementation determinants from the perspective of implementing organizations. BWS findings can inform other organizations interested in implementing PGx testing for mental health. Further, this study demonstrates the application of BWS to PGx, the findings of which may be used by other organizations to inform implementation of PGx testing for mental health disorders. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00300-7.
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Affiliation(s)
- Ramzi G Salloum
- University of Florida Clinical and Translational Science Institute, Gainesville, FL, USA.,University of Florida College of Medicine, Gainesville, FL, USA
| | - Jeffrey R Bishop
- University of Minnesota Medical School, Minneapolis, MN, USA.,University of Minnesota College of Pharmacy, Minneapolis, MN, USA
| | | | - D Max Smith
- MedStar Health, Georgetown University Medical Center, Washington, DC, USA
| | - Elizabeth Rowe
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Nita A Limdi
- University of Alabama Heersink School of Medicine, Birmingham, AL, USA
| | | | - Jill Bates
- Durham VA Healthcare System, Durham, NC, USA
| | | | - Amber Cipriani
- University of North Carolina Medical Center, Chapel Hill, NC, USA
| | | | - Philip E Empey
- University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | | | | | - Pawel Mroz
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - David Oslin
- Corporal Michael J. Cresenz VA Medical Center, Philadelphia, PA, USA
| | - Amy L Pasternak
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Natasha Petry
- North Dakota State University/Sanford Health, Fargo, ND, USA
| | - Laura B Ramsey
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Sandra M Swain
- MedStar Health, Georgetown University Medical Center, Washington, DC, USA
| | - Kristen M Ward
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - Todd C Skaar
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Larisa H Cavallari
- University of Florida Clinical and Translational Science Institute, Gainesville, FL, USA.,University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Sony Tuteja
- University of Pennsylvania Perelman School of Medicine, Smilow Center for Translational Research, 3400 Civic Center Boulevard, Bldg. 421 11th Floor, Room 143, Philadelphia, PA, 19104-5158, USA.
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5
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Wang L, Scherer SE, Bielinski SJ, Muzny DM, Jones LA, Black JL, Moyer AM, Giri J, Sharp RR, Matey ET, Wright JA, Oyen LJ, Nicholson WT, Wiepert M, Sullard T, Curry TB, Vitek CRR, McAllister TM, Sauver JL, Caraballo PJ, Lazaridis KN, Venner E, Qin X, Hu J, Kovar CL, Korchina V, Walker K, Doddapaneni H, Wu TJ, Raj R, Denson S, Liu W, Chandanavelli G, Zhang L, Wang Q, Kalra D, Karow MB, Harris KJ, Sicotte H, Peterson SE, Barthel AE, Moore BE, Skierka JM, Kluge ML, Kotzer KE, Kloke K, Vander Pol JM, Marker H, Sutton JA, Kekic A, Ebenhoh A, Bierle DM, Schuh MJ, Grilli C, Erickson S, Umbreit A, Ward L, Crosby S, Nelson EA, Levey S, Elliott M, Peters SG, Pereira N, Frye M, Shamoun F, Goetz MP, Kullo IJ, Wermers R, Anderson JA, Formea CM, El Melik RM, Zeuli JD, Herges JR, Krieger CA, Hoel RW, Taraba JL, Thomas SR, Absah I, Bernard ME, Fink SR, Gossard A, Grubbs PL, Jacobson TM, Takahashi P, Zehe SC, Buckles S, Bumgardner M, Gallagher C, Fee-Schroeder K, Nicholas NR, Powers ML, Ragab AK, Richardson DM, Stai A, Wilson J, Pacyna JE, Olson JE, Sutton EJ, Beck AT, Horrow C, Kalari KR, Larson NB, Liu H, Wang L, Lopes GS, Borah BJ, Freimuth RR, Zhu Y, Jacobson DJ, Hathcock MA, Armasu SM, McGree ME, Jiang R, Koep TH, Ross JL, Hilden M, Bosse K, Ramey B, Searcy I, Boerwinkle E, Gibbs RA, Weinshilboum RM. Implementation of preemptive DNA sequence-based pharmacogenomics testing across a large academic medical center: The Mayo-Baylor RIGHT 10K Study. Genet Med 2022; 24:1062-1072. [PMID: 35331649 PMCID: PMC9272414 DOI: 10.1016/j.gim.2022.01.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The Mayo-Baylor RIGHT 10K Study enabled preemptive, sequence-based pharmacogenomics (PGx)-driven drug prescribing practices in routine clinical care within a large cohort. We also generated the tools and resources necessary for clinical PGx implementation and identified challenges that need to be overcome. Furthermore, we measured the frequency of both common genetic variation for which clinical guidelines already exist and rare variation that could be detected by DNA sequencing, rather than genotyping. METHODS Targeted oligonucleotide-capture sequencing of 77 pharmacogenes was performed using DNA from 10,077 consented Mayo Clinic Biobank volunteers. The resulting predicted drug response-related phenotypes for 13 genes, including CYP2D6 and HLA, affecting 21 drug-gene pairs, were deposited preemptively in the Mayo electronic health record. RESULTS For the 13 pharmacogenes of interest, the genomes of 79% of participants carried clinically actionable variants in 3 or more genes, and DNA sequencing identified an average of 3.3 additional conservatively predicted deleterious variants that would not have been evident using genotyping. CONCLUSION Implementation of preemptive rather than reactive and sequence-based rather than genotype-based PGx prescribing revealed nearly universal patient applicability and required integrated institution-wide resources to fully realize individualized drug therapy and to show more efficient use of health care resources.
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Affiliation(s)
- Liewei Wang
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN,Division of Clinical Pharmacology, Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN
| | - Steven E. Scherer
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Suzette J. Bielinski
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Donna M. Muzny
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | - Leila A. Jones
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - John Logan Black
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Ann M. Moyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jyothsna Giri
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Wayne T. Nicholson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Mathieu Wiepert
- Department of Information Technology, Mayo Clinic, Rochester, MN
| | - Terri Sullard
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Timothy B. Curry
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN,Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Jennifer L. Sauver
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Pedro J. Caraballo
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Konstantinos N. Lazaridis
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Eric Venner
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | - Xiang Qin
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Jianhong Hu
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | - Christie L. Kovar
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | - Viktoriya Korchina
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | - Kimberly Walker
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | | | - Tsung-Jung Wu
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | - Ritika Raj
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | - Shawn Denson
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | - Wen Liu
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | - Gauthami Chandanavelli
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | - Lan Zhang
- Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX
| | - Qiaoyan Wang
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Divya Kalra
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX
| | - Mary Beth Karow
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Hugues Sicotte
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Sandra E. Peterson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Amy E. Barthel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Brenda E. Moore
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Michelle L. Kluge
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Katrina E. Kotzer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Karen Kloke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Heather Marker
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Joseph A. Sutton
- Department of Information Technology, Mayo Clinic, Rochester, MN
| | | | | | - Dennis M. Bierle
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Audrey Umbreit
- Department of Pharmacy, Mayo Clinic Health System, Mankato, MN
| | - Leah Ward
- Department of Pharmacy, Mayo Clinic, Jacksonville, FL
| | - Sheena Crosby
- Department of Pharmacy, Mayo Clinic, Jacksonville, FL
| | | | - Sharon Levey
- Department of Clinical Genomics, Mayo Clinic, Scottsdale, AZ
| | - Michelle Elliott
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Steve G. Peters
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Naveen Pereira
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Mark Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Fadi Shamoun
- Department of Cardiovascular Medicine Mayo Clinic, Phoenix, AZ
| | - Matthew P. Goetz
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN
| | | | - Robert Wermers
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | - Scott R. Thomas
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Imad Absah
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Stephanie R. Fink
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Andrea Gossard
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Paul Takahashi
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Susan Buckles
- Department of Public Affairs, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Melody L. Powers
- Biospecimens Accessioning and Processing Laboratory, Mayo Clinic, Rochester, MN
| | - Ahmed K. Ragab
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | | | - Anthony Stai
- Department of Information Technology, Mayo Clinic, Rochester, MN
| | - Jaymi Wilson
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Joel E. Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Janet E. Olson
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN,Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Erica J. Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Annika T. Beck
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Caroline Horrow
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Krishna R. Kalari
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Nicholas B. Larson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Hongfang Liu
- Division of Digital Health Sciences, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Liwei Wang
- Division of Digital Health Sciences, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Guilherme S. Lopes
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Bijan J. Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Robert R. Freimuth
- Division of Digital Health Sciences, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ye Zhu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Debra J. Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Matthew A. Hathcock
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sebastian M. Armasu
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Michaela E. McGree
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ruoxiang Jiang
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | - Eric Boerwinkle
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX,Human Genome Sequencing Center Clinical Laboratory, Baylor College of Medicine, Houston, TX,School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Richard A. Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX,Corresponding Authors (), ()
| | - Richard M. Weinshilboum
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN,Division of Clinical Pharmacology, Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN,Corresponding Authors (), ()
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6
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Formea CM, Schultz AJ, Empey PE. Pharmacists Closing Health Disparity Gaps through Pharmacogenomics. J Am Coll Clin Pharm 2022. [DOI: 10.1002/jac5.1629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christine M. Formea
- Intermountain Healthcare, Department of Pharmacy Services Salt Lake City Utah
- Intermountain Precision Genomics, Intermountain Healthcare St. George Utah
| | - April J. Schultz
- Sanford Imagenetics, Sanford Health Sioux Falls South Dakota
- Sanford USD School of Medicine University of South Dakota Sioux Falls South Dakota
| | - Philip E. Empey
- School of Pharmacy University of Pittsburgh Pittsburgh Pennsylvania
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7
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Smith DM, Stevenson JM, Ho TT, Formea CM, Gammal RS, Cavallari LH. Pharmacogenetics: A Precision Medicine Approach to Combatting the Opioid Epidemic. J Am Coll Clin Pharm 2022; 5:239-250. [PMID: 35784584 PMCID: PMC9248444 DOI: 10.1002/jac5.1582] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ineffective pain control is the most commonly cited reason for misuse of prescription opioids and is influenced by genetics. In particular, the gene encoding the CYP2D6 enzyme, which metabolizes some of the most commonly prescribed opioids (e.g., tramadol, hydrocodone) to their more potent forms, is highly polymorphic and can lead to reduced concentrations of the active metabolites and decreased opioid effectiveness. Consideration of the CYP2D6 genotype may allow for predicting opioid response and identifying patients who are likely to respond well to lower potency opioids as well as those who may derive greater pain relief from non-opioid analgesics versus certain opioids. There is emerging evidence that a CYP2D6-guided approach to pain management improves pain control and reduces opioid consumption and thus may be a promising means for combating opioid misuse. Clinical practice guidelines are available for select opioids and other analgesics to support medication and dose selection based on pharmacogenetic data. This article describes the evidence supporting genotype-guided pain management as a means of improving pain control and reducing opioid misuse and clinical recommendations for genotype-guided analgesic prescribing. In addition, a "how to" guide using patient case examples is provided to demystify the process for implementing pharmacogenetics-guided pain management in order to optimize analgesia and minimize adverse effects. Optimizing pain management through genotype-guided approaches may ultimately provide safer and more effective therapy for pain control while decreasing the risk for opioid misuse.
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Affiliation(s)
- D. Max Smith
- MedStar Health, Columbia, Maryland, USA.,Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - James M. Stevenson
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa T. Ho
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida, Tampa, Florida, USA
| | - Christine M. Formea
- Department of Pharmacy and Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Roseann S. Gammal
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA.,Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
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8
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Tuteja S, Salloum RG, Elchynski AL, Smith DM, Rowe E, Blake KV, Limdi NA, Aquilante CL, Bates J, Beitelshees AL, Cipriani A, Duong BQ, Empey PE, Formea CM, Hicks JK, Mroz P, Oslin D, Pasternak AL, Petry N, Ramsey LB, Schlichte A, Swain SM, Ward KM, Wiisanen K, Skaar TC, Van Driest SL, Cavallari LH, Bishop JR. Multisite evaluation of institutional processes and implementation determinants for pharmacogenetic testing to guide antidepressant therapy. Clin Transl Sci 2021; 15:371-383. [PMID: 34562070 PMCID: PMC8841452 DOI: 10.1111/cts.13154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022] Open
Abstract
There is growing interest in utilizing pharmacogenetic (PGx) testing to guide antidepressant use, but there is lack of clarity on how to implement testing into clinical practice. We administered two surveys at 17 sites that had implemented or were in the process of implementing PGx testing for antidepressants. Survey 1 collected data on the process and logistics of testing. Survey 2 asked sites to rank the importance of Consolidated Framework for Implementation Research (CFIR) constructs using best‐worst scaling choice experiments. Of the 17 sites, 13 had implemented testing and four were in the planning stage. Thirteen offered testing in the outpatient setting, and nine in both outpatient/inpatient settings. PGx tests were mainly ordered by psychiatry (92%) and primary care (69%) providers. CYP2C19 and CYP2D6 were the most commonly tested genes. The justification for antidepressants selected for PGx guidance was based on Clinical Pharmacogenetics Implementation Consortium guidelines (94%) and US Food and Drug Administration (FDA; 75.6%) guidance. Both institutional (53%) and commercial laboratories (53%) were used for testing. Sites varied on the methods for returning results to providers and patients. Sites were consistent in ranking CFIR constructs and identified patient needs/resources, leadership engagement, intervention knowledge/beliefs, evidence strength and quality, and the identification of champions as most important for implementation. Sites deployed similar implementation strategies and measured similar outcomes. The process of implementing PGx testing to guide antidepressant therapy varied across sites, but key drivers for successful implementation were similar and may help guide other institutions interested in providing PGx‐guided pharmacotherapy for antidepressant management.
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Affiliation(s)
- Sony Tuteja
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ramzi G Salloum
- University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - D Max Smith
- MedStar Health, Georgetown University Medical Center, Washington, DC, USA
| | - Elizabeth Rowe
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Nita A Limdi
- University of Alabama School of Medicine, Birmingham, Alabama, USA
| | | | - Jill Bates
- Durham VA Healthcare System, Durham, North Carolina, USA
| | | | - Amber Cipriani
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | - Philip E Empey
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | | | | | - Pawel Mroz
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - David Oslin
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Amy L Pasternak
- University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Natasha Petry
- North Dakota State University/Sanford Health, Fargo, North Dakota, USA
| | - Laura B Ramsey
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Sandra M Swain
- MedStar Health, Georgetown University Medical Center, Washington, DC, USA
| | - Kristen M Ward
- University of Michigan College of Pharmacy, Ann Arbor, Michigan, USA
| | - Kristin Wiisanen
- University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Todd C Skaar
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Jeffrey R Bishop
- University of Minnesota Medical School, Minneapolis, Minnesota, USA.,University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA
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9
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Nelsen G, Pigott H, Hopkinson C, Formea CM. Considerations for development of pharmacy support models for COVID-19 alternate care sites. Am J Health Syst Pharm 2021; 77:1592-1597. [PMID: 34279583 PMCID: PMC7337729 DOI: 10.1093/ajhp/zxaa214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Guidance on alternate care site planning based on the experience of a health-system pharmacy department in preparing for an expected surge in coronavirus disease 2019 (COVID-19) cases is provided. Summary In disaster response situations such as the COVID-19 pandemic, healthcare institutions may be compelled to transition to a contingency care model in which staffing and supply levels are no longer consistent with daily practice norms and, while usual patient care practices are maintained, establishment of alternate care sites (eg, a convention center) may be necessitated by high patient volumes. Available resources to assist hospitals and health systems in alternate care site planning include online guidance posted within the COVID-19 resources section of the US Army Corps of Engineers website, which provides recommended medication and supply lists; and the Federal Healthcare Resilience Task Force’s alternate care site toolkit, a comprehensive resource for all aspects of alternate care site planning, including pharmacy services. Important pharmacy planning issues include security and storage of drugs, state board of pharmacy and Drug Enforcement Administration licensing considerations, and staff credentialing, education, and training. Key medication management issues to be addressed in alternate site care planning include logistical challenges of supply chain maintenance, optimal workflow for compounded sterile preparations (eg, on-site preparation vs off-site preparation and delivery from a nearby hospital), and infusion pump availability and suitability to patient acuity levels. Conclusion Planning for and operation of alternate care sites in disaster response situations should include involvement of pharmacists in key decision-making processes at the earliest planning stages.
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Affiliation(s)
- Greg Nelsen
- Department of Pharmacy, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT
| | | | - Caleb Hopkinson
- Department of Pharmacy, Utah Valley Hospital, Intermountain Healthcare, Provo, UT
| | - Christine M Formea
- Department of Pharmacy and Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT
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10
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Rogers SL, Patrinos GP, Mitropoulou C, Formea CM, Jones JS, Brown BG. Inaugural Pharmacogenomics Access and Reimbursement Symposium. Pharmacogenomics 2021; 22:515-517. [PMID: 34032472 DOI: 10.2217/pgs-2021-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The Pharmacogenomics Access & Reimbursement Symposium, a landmark event presented by the Golden Helix Foundation and the Pharmacogenomics Access & Reimbursement Coalition, was a 1-day interactive meeting comprised of plenary keynotes from thought leaders across healthcare that focused on value-based strategies to improve patient access to personalized medicine. Stakeholders including patients, healthcare providers, industry, government agencies, payer organizations, health systems and health policy organizations convened to define opportunities to improve patient access to personalized medicine through best practices, successful reimbursement models, high quality economic evaluations and strategic alignment. Session topics included health technology assessment, health economics, health policy and value-based payment models and innovation.
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Affiliation(s)
- Sara L Rogers
- American Society of Pharmacovigilance, Houston, TX 77225, USA
| | - George P Patrinos
- Department of Pharmacy, University of Patras, School of Health Sciences, Patras, 265 04, Greece.,Department of Pathology, United Arab Emirates University, College of Medicine & Health Sciences, Al-Ain, UAE.,United Arab Emirates University, Zayed Center of Health Sciences, Al-Ain, UAE
| | | | - Christine M Formea
- Department of Pharmacy Services & Intermountain Precision Genomics, Intermountain Healthcare Pharmacy Services, Taylorsville, UT 84123, USA
| | - J Shawn Jones
- Texas Tech University Health Sciences Center, Jerry H Hodge School of Pharmacy, Dallas, TX 75235, USA
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11
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Rogers SL, Patrinos GP, Mitropoulou C, Formea CM, Shawn Jones J, Brown BG. Conference report: inaugural Pharmacogenomics Access & Reimbursement Symposium. Pharmacogenomics J 2021; 21:622-624. [PMID: 34140646 PMCID: PMC8210499 DOI: 10.1038/s41397-021-00240-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/23/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
The Pharmacogenomics Access & Reimbursement Symposium, a landmark event presented by the Golden Helix Foundation and the Pharmacogenomics Access & Reimbursement Coalition (PARC), was a one-day interactive meeting comprised of plenary keynotes from thought leaders across health care that focused on value-based strategies to improve patient access to personalized medicine. Stakeholders including patients, healthcare providers, industry, government agencies, payer organizations, health systems and health policy organizations convened to define opportunities to improve patient access to personalized medicine through best practices, successful reimbursement models, high-quality economic evaluations, and strategic alignment. Session topics included health technology assessment, health economics, health policy, and value-based payment models and innovation.
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Affiliation(s)
| | - George P. Patrinos
- grid.11047.330000 0004 0576 5395Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece ,grid.43519.3a0000 0001 2193 6666Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al-Ain, UAE ,grid.43519.3a0000 0001 2193 6666Zayed Center of Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | | | - Christine M. Formea
- grid.420884.20000 0004 0460 774XDepartment of Pharmacy Services & Intermountain Precision Genomics, Intermountain Healthcare Pharmacy Services, Taylorsville, UT USA
| | - J. Shawn Jones
- grid.416992.10000 0001 2179 3554Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX USA
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12
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Nicholson WT, Formea CM, Matey ET, Wright JA, Giri J, Moyer AM. Considerations When Applying Pharmacogenomics to Your Practice. Mayo Clin Proc 2021; 96:218-230. [PMID: 33308868 DOI: 10.1016/j.mayocp.2020.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/24/2020] [Accepted: 03/17/2020] [Indexed: 10/22/2022]
Abstract
Many practitioners who have not had pharmacogenomic education are required to apply pharmacogenomics to their practices. Although many aspects of pharmacogenomics are similar to traditional concepts of drug-drug interactions, there are some differences. We searched PubMed with the search terms pharmacogenomics and pharmacogenetics (January 1, 2005, through December 31, 2019) and selected articles that supported the application of pharmacogenomics to practice. For inclusion, we gave preference to national and international consortium guidelines for implementation of pharmacogenomics. We discuss special considerations important in the application of pharmacogenomics to assist clinicians with ordering, interpreting, and applying pharmacogenomics in their practices.
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Affiliation(s)
- Wayne T Nicholson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN.
| | - Christine M Formea
- Intermountain Healthcare Department of Pharmacy Services Pharmacy Services, Salt Lake City, UT; Intermountain Precision Genomics, Intermountain Healthcare, St George, UT
| | - Eric T Matey
- Department of Pharmacy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Jessica A Wright
- Department of Pharmacy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Jyothsna Giri
- Mayo Clinic Center for Individualized Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Ann M Moyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
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13
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Lima JJ, Thomas CD, Barbarino J, Desta Z, Van Driest SL, El Rouby N, Johnson JA, Cavallari LH, Shakhnovich V, Thacker DL, Scott SA, Schwab M, Uppugunduri CRS, Formea CM, Franciosi JP, Sangkuhl K, Gaedigk A, Klein TE, Gammal RS, Furuta T. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C19 and Proton Pump Inhibitor Dosing. Clin Pharmacol Ther 2020; 109:1417-1423. [PMID: 32770672 DOI: 10.1002/cpt.2015] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/15/2020] [Indexed: 12/27/2022]
Abstract
Proton pump inhibitors (PPIs) are widely used for acid suppression in the treatment and prevention of many conditions, including gastroesophageal reflux disease, gastric and duodenal ulcers, erosive esophagitis, Helicobacter pylori infection, and pathological hypersecretory conditions. Most PPIs are metabolized primarily by cytochrome P450 2C19 (CYP2C19) into inactive metabolites, and CYP2C19 genotype has been linked to PPI exposure, efficacy, and adverse effects. We summarize the evidence from the literature and provide therapeutic recommendations for PPI prescribing based on CYP2C19 genotype (updates at www.cpicpgx.org). The potential benefits of using CYP2C19 genotype data to guide PPI therapy include (i) identifying patients with genotypes predictive of lower plasma exposure and prescribing them a higher dose that will increase the likelihood of efficacy, and (ii) identifying patients on chronic therapy with genotypes predictive of higher plasma exposure and prescribing them a decreased dose to minimize the risk of toxicity that is associated with long-term PPI use, particularly at higher plasma concentrations.
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Affiliation(s)
- John J Lima
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health, Jacksonville, Florida, USA
| | - Cameron D Thomas
- Department of Pharmacotherapy and Translational Research, and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Julia Barbarino
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Zeruesenay Desta
- Department of Medicine, Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sara L Van Driest
- Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Nihal El Rouby
- Department of Pharmacotherapy and Translational Research, and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA.,Division of Pharmacy Practice & Administrative Sciences, University of Cincinnati James Winkle College of Pharmacy, Cincinnati, Ohio, USA
| | - Julie A Johnson
- Department of Pharmacotherapy and Translational Research, and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Larisa H Cavallari
- Department of Pharmacotherapy and Translational Research, and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Valentina Shakhnovich
- Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Children's Mercy Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.,Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA
| | - David L Thacker
- Department of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Translational Software, Bellevue, Washington, USA
| | - Stuart A Scott
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Sema4, Stamford, Connecticut, USA
| | - Matthias Schwab
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany.,Department of Clinical Pharmacology, University Hospital, Tuebingen, Germany.,Department of Pharmacy and Biochemistry, University of Tuebingen, Tuebingen, Germany
| | - Chakradhara Rao S Uppugunduri
- CANSEARCH Research Laboratory, Department of Pediatrics, Gynecology, and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Oncology-Hematology Unit, Department of Pediatrics, Gynecology, and Obstetrics, Geneva University Hospital, Geneva, Switzerland
| | - Christine M Formea
- Department of Pharmacy Services and Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - James P Franciosi
- Division of Gastroenterology, Hepatology, and Nutrition, Nemours Children's Hospital, Orlando, Florida, USA.,Department of Pediatrics, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Katrin Sangkuhl
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Children's Mercy Kansas City and University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Teri E Klein
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Roseann S Gammal
- Department of Pharmacy Practice, MCPHS University School of Pharmacy, Boston, Massachusetts, USA.,Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Takahisa Furuta
- Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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14
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Karnes JH, Rettie AE, Somogyi AA, Huddart R, Fohner AE, Formea CM, Ta Michael Lee M, Llerena A, Whirl-Carrillo M, Klein TE, Phillips EJ, Mintzer S, Gaedigk A, Caudle KE, Callaghan JT. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and HLA-B Genotypes and Phenytoin Dosing: 2020 Update. Clin Pharmacol Ther 2020; 109:302-309. [PMID: 32779747 DOI: 10.1002/cpt.2008] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/25/2020] [Indexed: 12/19/2022]
Abstract
Phenytoin is an antiepileptic drug with a narrow therapeutic index and large interpatient pharmacokinetic variability, partly due to genetic variation in CYP2C9. Furthermore, the variant allele HLA-B*15:02 is associated with an increased risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in response to phenytoin treatment. We summarize evidence from the published literature supporting these associations and provide therapeutic recommendations for the use of phenytoin based on CYP2C9 and/or HLA-B genotypes (updates on cpicpgx.org).
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Affiliation(s)
- Jason H Karnes
- Department of Pharmacy Practice & Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
- Sarver Heart Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Allan E Rettie
- Department of Medicinal Chemistry, University of Washington School of Pharmacy, Seattle, Washington, USA
| | - Andrew A Somogyi
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel Huddart
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Alison E Fohner
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Institute of Public Health Genetics, University of Washington, Seattle, Washington, USA
| | - Christine M Formea
- Department of Pharmacy and Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Ming Ta Michael Lee
- Genomic Medicine Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Adrian Llerena
- INUBE Extremadura University Biosanitary Research Institute and Medical School, Badajoz, Spain
| | | | - Teri E Klein
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Elizabeth J Phillips
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott Mintzer
- Department of Neurology, Thomas Jefferson University Hospital Methodist Hospital Division of Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, Missouri, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Kelly E Caudle
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - John T Callaghan
- Department of Veteran Affairs and Departments of Medicine and Pharmacology/Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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15
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L Rogers S, Keeling NJ, Giri J, Gonzaludo N, Jones JS, Glogowski E, Formea CM. PARC report: a health-systems focus on reimbursement and patient access to pharmacogenomics testing. Pharmacogenomics 2020; 21:785-796. [DOI: 10.2217/pgs-2019-0192] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pharmacogenomics test coverage and reimbursement are major obstacles to clinical uptake. Several early adopter programs have been successfully initiated through dedicated investments by federal and institutional research funding. As a result of research endeavors, evidence has grown sufficiently to support development of pharmacogenomics guidelines. However, clinical uptake is still limited. Third-party payer support plays an important role in increasing adoption, which to date has been limited to reactive single-gene testing. Access to and interest in direct-to-consumer genetic testing are driving demand for increasing healthcare providers and third-party awareness of this burgeoning field. Pharmacogenomics implementation models developed by early adopters promise to expand patient access and options, as testing continues to increase due to growing consumer interest and falling test prices.
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Affiliation(s)
- Sara L Rogers
- American Society of Pharmacovigilance, PO Box 20433, Houston, TX 77225, USA
| | - Nicholas J Keeling
- Department of Pharmacy Administration, The University of Mississippi School of Pharmacy, 223 Faser Hall, MS 38677, USA
| | - Jyothsna Giri
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, MN 55905, USA
| | - Nina Gonzaludo
- Illumina, Inc., 200 Lincoln Centre Drive, Foster City, CA 94404, USA
| | - J Shawn Jones
- Texas Tech University Health Sciences Center, Jerry H. Hodge School of Pharmacy, 5920 Forest Park Rd, Suite 500, Dallas, TX 75235, USA
| | | | - Christine M Formea
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, MN 55905, USA
- Department of Pharmacy Services & Intermountain Precision Genomics, Intermountain Healthcare Pharmacy Services, 4393 S. Riverboat Road, Taylorsville, UT 84123, USA
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16
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Eichmeyer J, Rogers S, Formea CM, Giri J, Jones J, Schnettler E, Schmidlen T, Glogowski E, Kurz RN. PARC report: a perspective on the state of clinical pharmacogenomics testing. Pharmacogenomics 2020; 21:809-820. [DOI: 10.2217/pgs-2019-0193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In this Perspective, the authors discuss the state of pharmacogenomics testing addressing a number of advances, challenges and barriers, including legal ramifications, changes to the regulatory landscape, coverage of testing and the implications of direct-to-consumer genetic testing on the provision of care to patients. Patient attitudes toward pharmacogenomics testing and associated costs will play an increasingly important role in test acquisition and subsequent utilization in a clinical setting. Additional key steps needed include: further research trials demonstrating clinical utility and cost–effectiveness of pharmacogenetic testing, evidence review to better integrate genomic information into clinical practice guidelines in target therapeutic areas to help providers identify patients that may benefit from pharmacogenetic testing and engagement with payers to create a path to reimbursement for pharmacogenetic tests that currently have sufficient evidence of clinical utility. Increased adoption of testing by payers and improved reimbursement practices will be needed to overcome barriers, especially as the healthcare landscape continues to shift toward a system of value-based care.
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Affiliation(s)
- Jennifer Eichmeyer
- School of Allied Health Sciences, Boise State University, Boise, ID 83725, USA
| | - Sara Rogers
- American Society of Pharmacovigilance, Houston, TX 77225, USA
| | - Christine M Formea
- Department of Pharmacy Services, Intermountain Healthcare, Salt Lake City, UT 84123, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Jyothsna Giri
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - J Shawn Jones
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX 75216, USA
| | | | - Tara Schmidlen
- Genomic Medicine Institute, Geisinger, Danville, PA 17822, USA
| | | | - Raluca N Kurz
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA
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17
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Theken KN, Lee CR, Gong L, Caudle KE, Formea CM, Gaedigk A, Klein TE, Agúndez JAG, Grosser T. Clinical Pharmacogenetics Implementation Consortium Guideline (CPIC) for CYP2C9 and Nonsteroidal Anti-Inflammatory Drugs. Clin Pharmacol Ther 2020; 108:191-200. [PMID: 32189324 DOI: 10.1002/cpt.1830] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/29/2020] [Indexed: 12/20/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used analgesics due to their lack of addictive potential. However, NSAIDs have the potential to cause serious gastrointestinal, renal, and cardiovascular adverse events. CYP2C9 polymorphisms influence metabolism and clearance of several drugs in this class, thereby affecting drug exposure and potentially safety. We summarize evidence from the published literature supporting these associations and provide therapeutic recommendations for NSAIDs based on CYP2C9 genotype (updates at www.cpicpgx.org).
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Affiliation(s)
- Katherine N Theken
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Craig R Lee
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Li Gong
- Department of Biomedical Data Science and Department of Medicine, Stanford University, Stanford, California, USA
| | - Kelly E Caudle
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christine M Formea
- Department of Pharmacy and Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pharmacy and Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Andrea Gaedigk
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, Missouri, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Teri E Klein
- Department of Biomedical Data Science and Department of Medicine, Stanford University, Stanford, California, USA
| | - José A G Agúndez
- University Institute of Molecular Pathology Biomarkers, UEx. ARADyAL Instituto de Salud Carlos III, Cáceres, Spain
| | - Tilo Grosser
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Bielinski SJ, St Sauver JL, Olson JE, Larson NB, Black JL, Scherer SE, Bernard ME, Boerwinkle E, Borah BJ, Caraballo PJ, Curry TB, Doddapaneni H, Formea CM, Freimuth RR, Gibbs RA, Giri J, Hathcock MA, Hu J, Jacobson DJ, Jones LA, Kalla S, Koep TH, Korchina V, Kovar CL, Lee S, Liu H, Matey ET, McGree ME, McAllister TM, Moyer AM, Muzny DM, Nicholson WT, Oyen LJ, Qin X, Raj R, Roger VL, Rohrer Vitek CR, Ross JL, Sharp RR, Takahashi PY, Venner E, Walker K, Wang L, Wang Q, Wright JA, Wu TJ, Wang L, Weinshilboum RM. Cohort Profile: The Right Drug, Right Dose, Right Time: Using Genomic Data to Individualize Treatment Protocol (RIGHT Protocol). Int J Epidemiol 2020; 49:23-24k. [PMID: 31378813 PMCID: PMC7124480 DOI: 10.1093/ije/dyz123] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Suzette J Bielinski
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L St Sauver
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Janet E Olson
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicholas B Larson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - John L Black
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Steven E Scherer
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Eric Boerwinkle
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bijan J Borah
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Pedro J Caraballo
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy B Curry
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Robert R Freimuth
- Division of Digital Health Sciences, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Richard A Gibbs
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jyothsna Giri
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew A Hathcock
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jianhong Hu
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Leila A Jones
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sara Kalla
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Viktoriya Korchina
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Christie L Kovar
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Sandra Lee
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Hongfang Liu
- Division of Digital Health Sciences, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Eric T Matey
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Ann M Moyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Donna M Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Wayne T Nicholson
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lance J Oyen
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | - Xiang Qin
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Ritika Raj
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Véronique L Roger
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Richard R Sharp
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Paul Y Takahashi
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric Venner
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Kimberly Walker
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Liwei Wang
- Division of Digital Health Sciences, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Qiaoyan Wang
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Jessica A Wright
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | - Tsung-Jung Wu
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Liewei Wang
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Richard M Weinshilboum
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Clinical Pharmacology, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
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19
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Valgus J, Weitzel KW, Peterson JF, Crona DJ, Formea CM. Current practices in the delivery of pharmacogenomics: Impact of the recommendations of the Pharmacy Practice Model Summit. Am J Health Syst Pharm 2020; 76:521-529. [PMID: 31361863 DOI: 10.1093/ajhp/zxz024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE This report examines and evaluates pharmacogenomics as an emerging science as it relates to the Practice Advancement Initiative and its predecessor the Pharmacy Practice Model Initiative's consensus statements for optimal pharmacy practice models. SUMMARY Pharmacogenomics is one of many emerging sciences to impact medication management and delivery of patient care. Increasingly, biomarkers are included in drug labeling and can assist pharmacists with personalizing medicine to optimize patient therapies and avoid adverse effects. The 2011 ASHP Pharmacy Practice Model Summit generated a list of 147 consensus statements for optimal pharmacy practice. Of these, 1 statement explicitly describes adjustment of drug regimens based on genetic factors as an essential activity of pharmacist-provided drug regimens, and 9 other statements provide additional support for incorporation of this emerging science into all aspects of patient care provided by pharmacists. We describe 4 institutions that have made significant inroads to implementing pharmacogenomics, to provide a framework and serve as resources for other institutions initiating their own pharmacogenomics implementation journeys. CONCLUSION Through prioritized efforts of the pharmacy profession and health care institutions, pharmacogenomics will be disseminated and implemented, and the goal of the Pharmacy Practice Model Initiative's consensus statements of improving health care using patients' genetic characteristics will be realized.
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Affiliation(s)
- John Valgus
- Hematology/Oncology Pharmacy Services, University of North Carolina Healthcare, and UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Kristin W Weitzel
- UF Health Personalized Medicine Program, University of Florida, and Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL
| | | | - Daniel J Crona
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Christine M Formea
- Mayo Clinic College of Medicine, Hospital Pharmacy Services, Mayo Clinic, Rochester, MN
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20
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Caudle KE, Gammal RS, Karnes JH, Afanasjeva J, Anderson KC, Barreto EF, Beavers C, Bhat S, Birrer KL, Chahine EB, Ensor CR, Flowers SA, Formea CM, George JM, Gosser RA, Hebert MF, Karaoui LR, Kolpek JH, Lee JC, Leung JG, Maldonado AQ, Minze MG, Pulk RA, Shelton CM, Sheridan M, Smith MA, Soefje S, Tellez-Corrales E, Walko CM, Cavallari LH. PRN OPINION PAPER: Application of precision medicine across pharmacy specialty areas. J Am Coll Clin Pharm 2019. [DOI: 10.1002/jac5.1107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Kelly E. Caudle
- Department of Pharmaceutical Sciences; St. Jude Children's Research Hospital; Memphis Tennessee
| | - Roseann S. Gammal
- Department of Pharmaceutical Sciences; St. Jude Children's Research Hospital; Memphis Tennessee
- Department of Pharmacy Practice; MCPHS University School of Pharmacy; Boston Massachusetts
| | - Jason H. Karnes
- Department of Pharmacy Practice and Science; University of Arizona College of Pharmacy; Tucson Arizona
| | - Janna Afanasjeva
- Drug Information Group; University of Illinois College of Pharmacy; Chicago Illinois
| | | | - Erin F. Barreto
- Department of Pharmacy; Mayo Clinic; Rochester Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery; Mayo Clinic; Rochester Minnesota
| | - Craig Beavers
- Department of Pharmacy Service; University of Kentucky Healthcare; Lexington Kentucky
- Department of Pharmacy Practice & Science; University of Kentucky College of Pharmacy; Lexington Kentucky
| | - Shubha Bhat
- Department of Pharmacy; Boston Medical Center; Boston Massachusetts
| | - Kara L. Birrer
- Pharmacy Services, Orlando Regional Medical Center/Orlando Health; Orlando Florida
| | - Elias B. Chahine
- Department of Pharmacy Practice; Palm Beach Atlantic University Lloyd L. Gregory School of Pharmacy; West Palm Beach Florida
| | | | - Stephanie A. Flowers
- Department of Pharmacy Practice; University of Illinois at Chicago; Chicago Illinois
| | | | - Jomy M. George
- Clinical Pharmacokinetics Research Unit, Clinical Center Pharmacy; National Institutes of Health; Bethesda Maryland
| | - Rena A. Gosser
- Department of Pharmacy; University of Washington Medicine; Seattle Washington
| | - Mary F. Hebert
- Departments of Pharmacy and Obstetrics & Gynecology; University of Washington; Seattle Washington
| | - Lamis R. Karaoui
- Department of Pharmacy Practice; Lebanese American University School of Pharmacy; Byblos Lebanon
| | - Jimmi Hatton Kolpek
- Department of Pharmacy Practice & Science; University of Kentucky College of Pharmacy; Lexington Kentucky
| | - James C. Lee
- Department of Pharmacy Practice; University of Illinois at Chicago; Chicago Illinois
| | | | - Angela Q. Maldonado
- Department of Transplant Surgery; Vidant Medical Center; Greenville North Carolina
| | - Molly G. Minze
- Department of Pharmacy Practice; Texas Tech University Health Sciences Center School of Pharmacy; Abilene Texas
| | - Rebecca A. Pulk
- Corporate Pharmacy Services; Yale New Haven Health; New Haven Connecticut
| | - Chasity M. Shelton
- Department of Clinical Pharmacy and Translational Science; The University of Tennessee Health Science Center; Memphis Tennessee
| | | | - Michael A. Smith
- Department of Clinical Pharmacy; University of Michigan; Ann Arbor Michigan
| | - Scott Soefje
- Department of Pharmacy Services; Mayo Clinic; Rochester Minnesota
| | - Eglis Tellez-Corrales
- Department Pharmacy Practice, College of Pharmacy; Marshall B Ketchum University; Fullerton California
| | - Christine M. Walko
- DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center; Tampa Florida
- Department of Oncologic Sciences, Morsani College of Medicine; University of South Florida; Tampa Florida
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics; University of Florida; Gainesville Florida
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21
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Formea CM, Nicholson WT, Vitek CR, Wix KK, McCullough KB, Cunningham JL, Zeuli JD, Matey ET, Merten JA, Richardson DM, Billings AL, Schramm GE. Implementation of a pharmacogenomics education program for pharmacists. Am J Health Syst Pharm 2018; 75:1939-1946. [PMID: 30301720 DOI: 10.2146/ajhp170771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The development, implementation, and evaluation of a pharmacogenomics education program for pharmacists in a large, integrated multicampus health system are described. SUMMARY Pharmacogenomics has been described as tailoring medications to each patient's unique genetic sequence with the goals of minimizing harmful effects and optimizing therapeutic effects. Pharmacists are uniquely trained to lead the implementation of pharmacogenomics in clinical care. After assessment of pharmacists' comfort with pharmacogenomics, different approaches were explored to develop, pilot test, and disseminate pharmacogenomics education across a multicampus academic medical center. Limited success with large-audience, single-lecture didactic education led to development and delivery of targeted, competency-based online modules using the institution's academic virtual learning environment and course management system. Implementation steps included (1) collaboration with the Mayo Clinic Center for Individualized Medicine to create an interprofessional development team and project charter, (2) galvanizing pharmacy leadership support across multiple campuses, (3) development of competency-based interactive modules, and (4) assessment of the quality of and learner satisfaction with the modules. Significant improvements in competency scores were observed with each module and across the multiple campuses. Satisfaction with the education program was assessed at the end of a 4-module series. CONCLUSION A pharmacogenomics educational program targeting pharmacists was developed through interprofessional collaboration and provided a novel opportunity to construct an educational infrastructure to support enterprise health-system campuses with limited educational resources.
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Affiliation(s)
- Christine M Formea
- Department of Pharmacy, Mayo Clinic College of Medicine, Rochester, MN, and Mayo Clinic Hospital-Rochester, Rochester, MN
| | - Wayne T Nicholson
- Department of Anesthesiology, Mayo Clinic Hospital-Rochester, Rochester, MN
| | | | - Kelly K Wix
- Department of Pharmacy, Mayo Clinic, Rochester, MN
| | | | | | - John D Zeuli
- Department of Pharmacy, Mayo Clinic, Rochester, MN
| | - Eric T Matey
- Department of Pharmacy, Mayo Clinic, Rochester, MN
| | | | | | - Andrea L Billings
- Department of Pharmacy, Mayo Clinic Hospital-Rochester, Rochester, MN
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22
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Ubanyionwu S, Formea CM, Anderson B, Wix K, Dierkhising R, Caraballo PJ. Evaluation of prescriber responses to pharmacogenomics clinical decision support for thiopurine S-methyltransferase testing. Am J Health Syst Pharm 2018; 75:191-198. [PMID: 29436466 DOI: 10.2146/ajhp170280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of a study of prescribers' responses to a pharmacogenomics-based clinical decision support (CDS) alert designed to prompt thiopurine S-methyltransferase (TPMT) status testing are reported. METHODS A single-center, retrospective, chart review-based study was conducted to evaluate prescriber compliance with a pretest CDS alert that warned of potential thiopurine drug toxicity resulting from deficient TPMT activity due to TPMT gene polymorphism. The CDS alert was triggered when prescribers ordered thiopurine drugs for patients whose records did not indicate TPMT status or when historical thiopurine use was documented in the electronic health record. The alert pop-up also provided a link to online educational resources to guide thiopurine dosing calculations. RESULTS During the 9-month study period, 500 CDS alerts were generated: in 101 cases (20%), TPMT phenotyping or TPMT genotyping was ordered; in 399 cases (80%), testing was not ordered. Multivariable regression analysis indicated that documentation of historical thiopurine use was the only independent predictor of test ordering. Among the 99 patients tested subsequent to CDS alerts, 70 (71%) had normal TPMT activity, 29 (29%) had intermediate activity, and none had deficient activity. The online resources provided thiopurine dosing recommendations applicable to 24 patients, but only 3 were prescribed guideline-supported doses after CDS alerts. CONCLUSION The pretest CDS rule resulted in a large proportion of neglected alerts due to poor alerting accuracy and consequent alert fatigue. Prescriber usage of online thiopurine dosing resources was low.
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Affiliation(s)
| | | | | | - Kelly Wix
- Department of Pharmacy Services, Mayo Clinic, Rochester, MN
| | - Ross Dierkhising
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Pedro J Caraballo
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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23
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Giri J, Curry TB, Formea CM, Nicholson WT, Rohrer Vitek CR. Education and Knowledge in Pharmacogenomics: Still a Challenge? Clin Pharmacol Ther 2018; 103:752-755. [DOI: 10.1002/cpt.1019] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Jyothsna Giri
- Mayo Clinic College of Medicine, Center for Individualized Medicine; Rochester Minnesota USA
| | - Timothy B. Curry
- Mayo Clinic College of Medicine, Department of Anesthesiology and Perioperative Medicine; Rochester Minnesota USA
| | - Christine M. Formea
- Mayo Clinic College of Medicine, Department of Pharmacy; Rochester Minnesota USA
| | - Wayne T. Nicholson
- Mayo Clinic College of Medicine, Department of Anesthesiology and Perioperative Medicine; Rochester Minnesota USA
| | - Carolyn R. Rohrer Vitek
- Mayo Clinic College of Medicine, Center for Individualized Medicine; Rochester Minnesota USA
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24
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Freimuth RR, Formea CM, Hoffman JM, Matey E, Peterson JF, Boyce RD. Implementing Genomic Clinical Decision Support for Drug-Based Precision Medicine. CPT Pharmacometrics Syst Pharmacol 2017; 6:153-155. [PMID: 28109071 PMCID: PMC5351408 DOI: 10.1002/psp4.12173] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 11/07/2022]
Abstract
The explosive growth of patient-specific genomic information relevant to drug therapy will continue to be a defining characteristic of biomedical research. To implement drug-based personalized medicine (PM) for patients, clinicians need actionable information incorporated into electronic health records (EHRs). New clinical decision support (CDS) methods and informatics infrastructure are required in order to comprehensively integrate, interpret, deliver, and apply the full range of genomic data for each patient.
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Affiliation(s)
- R R Freimuth
- Department of Health Sciences Research, Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - C M Formea
- Department of Pharmacy, Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - J M Hoffman
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - E Matey
- Department of Pharmacy, Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - J F Peterson
- Department of Biomedical Informatics and Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R D Boyce
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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25
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Barajas MR, Formea CM, McCormick JB, Abdalrhim AD, Han LC, McBane RD, Fiksdal AS, Kullo IJ. A patient-centered approach to the development and pilot of a warfarin pharmacogenomics patient education tool for health professionals. Curr Pharm Teach Learn 2015; 7:249-255. [PMID: 25729462 PMCID: PMC4339072 DOI: 10.1016/j.cptl.2014.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe an exploratory project to develop and pilot a novel patient educational tool that explains the concept of pharmacogenomics and its impact on warfarin dosing that can be utilized by health professionals providing patient counseling. METHODS A pharmacogenomics educational tool prototype was developed by an interdisciplinary team. During the pilot of the tool, focus group methodology was used to elicit input from patients based upon their perspectives and experiences with warfarin. Focus group sessions were audio-recorded and transcribed, and the data was analyzed through consensus coding in NVivo. RESULTS The focus group participants were generally unfamiliar with the concept of pharmacogenomics but were receptive to the information. They thought the patient education tool was informative and would provide the most benefit to patients newly initiated on warfarin therapy. CONCLUSIONS Preliminary results from this exploratory project suggest that implementation and further feasibility testing of this pharmacogenomics patient education tool should be performed in a population of newly initiated patients taking warfarin.
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Affiliation(s)
- Megan R Barajas
- Hospital Pharmacy Services, Mayo Clinic Hospital-St. Marys Campus, 200 First Street SW, Rochester, MN 55905,
| | - Christine M Formea
- Hospital Pharmacy Services, Mayo Clinic Hospital-St. Marys Campus, 200 First Street SW, Rochester, MN 55905, 1-507-255-7552,
| | - Jennifer B McCormick
- Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Ahmed D Abdalrhim
- Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Leona C Han
- Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Robert D McBane
- Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Alexander S Fiksdal
- Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
| | - Iftikhar J Kullo
- Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905,
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26
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Abstract
Personalized medicine offers the promise of better diagnoses, targeted therapies and individualized treatment plans. Pharmacogenomics is an integral component of personalized medicine; it aids in the prediction of an individual's response to medications. Despite growing public acceptance and emerging clinical evidence, this rapidly expanding field of medicine is slow to be adopted and utilized by healthcare providers, although many believe that they should be knowledgeable and able to apply pharmacogenomics in clinical practice. Institutional infrastructure must be built to support pharmacogenomic implementation. Multidisciplinary education for healthcare providers is a critical component for pharmacogenomics to achieve its full potential to optimize patient care. We describe our recent experience at the Mayo Clinic implementing pharmacogenomics education in a large, academic healthcare system facilitated by the Mayo Clinic Center for Individualized Medicine.
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Affiliation(s)
- Christine M Formea
- Hospital Pharmacy Services, Mary Brigh Building G-722, Mayo Clinic Hospital-St Marys Campus, 200 First Street SW, Rochester, MN 55905, USA
| | - Wayne T Nicholson
- Department of Anesthesiology, Mayo Clinic Hospital-St Marys Campus, 200 First Street, Rochester, MN 55905, USA
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27
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Formea CM, Mohamed AA, Hassan A, Osman A, Weis JA, Sia IG, Wieland ML. Lessons learned: cultural and linguistic enhancement of surveys through community-based participatory research. Prog Community Health Partnersh 2015; 8:331-6. [PMID: 25435559 DOI: 10.1353/cpr.2014.0037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Nicholson WT, Formea CM. Clinical perspective on the Clinical Pharmacogenetics Implementation Consortium Updated 2014 guidelines for CYP2D6 and codeine. Clin Chem 2014; 61:319-21. [PMID: 25301855 DOI: 10.1373/clinchem.2014.226795] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Wayne T Nicholson
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN.
| | - Christine M Formea
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN
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29
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Tiedje K, Wieland ML, Meiers SJ, Mohamed AA, Formea CM, Ridgeway JL, Asiedu GB, Boyum G, Weis JA, Nigon JA, Patten CA, Sia IG. A focus group study of healthy eating knowledge, practices, and barriers among adult and adolescent immigrants and refugees in the United States. Int J Behav Nutr Phys Act 2014; 11:63. [PMID: 24886062 PMCID: PMC4030459 DOI: 10.1186/1479-5868-11-63] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 05/12/2014] [Indexed: 11/23/2022] Open
Abstract
Background Immigrants and refugees to the United States exhibit lower dietary quality than the general population, but reasons for this disparity are poorly understood. In this study, we describe the meanings of food, health and wellbeing through the reported dietary preferences, beliefs, and practices of adults and adolescents from four immigrant and refugee communities in the Midwestern United States. Methods Using a community based participatory research approach, we conducted a qualitative research study with 16 audio-recorded focus groups with adults and adolescents who self-identified as Mexican, Somali, Cambodian, and Sudanese. Focus group topics were eating patterns, perceptions of healthy eating in the country of origin and in the U.S., how food decisions are made and who in the family is involved in food preparation and decisions, barriers and facilitators to healthy eating, and gender and generational differences in eating practices. A team of investigators and community research partners analyzed all transcripts in full before reducing data to codes through consensus. Broader themes were created to encompass multiple codes. Results Results show that participants have similar perspectives about the barriers (personal, environmental, structural) and benefits of healthy eating (e.g., ‘junk food is bad’). We identified four themes consistent across all four communities: Ways of Knowing about Healthy Eating (‘Meanings;’ ‘Motivations;’ ‘Knowledge Sources’), Eating Practices (‘Family Practices;’ ‘Americanized Eating Practices’ ‘Eating What’s Easy’), Barriers (‘Taste and Cravings;’ ‘Easy Access to Junk Food;’ ‘Role of Family;’ Cultural Foods and Traditions;’ ‘Time;’ ‘Finances’), and Preferences for Intervention (‘Family Counseling;’ Community Education;’ and ‘Healthier Traditional Meals.’). Some generational (adult vs. adolescents) and gender differences were observed. Conclusions Our study demonstrates how personal, structural, and societal/cultural factors influence meanings of food and dietary practices across immigrant and refugee populations. We conclude that cultural factors are not fixed variables that occur independently from the contexts in which they are embedded.
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Affiliation(s)
| | - Mark L Wieland
- Department of Medicine, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA.
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Formea CM, Nicholson WT, McCullough KB, Berg KD, Berg ML, Cunningham JL, Merten JA, Ou NN, Stollings JL. Development and evaluation of a pharmacogenomics educational program for pharmacists. Am J Pharm Educ 2013; 77:10. [PMID: 23459098 PMCID: PMC3578323 DOI: 10.5688/ajpe77110] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 09/21/2012] [Indexed: 05/09/2023]
Abstract
Objectives. To evaluate hospital and outpatient pharmacists' pharmacogenomics knowledge before and 2 months after participating in a targeted, case-based pharmacogenomics continuing education program.Design. As part of a continuing education program accredited by the Accreditation Council for Pharmacy Education (ACPE), pharmacists were provided with a fundamental pharmacogenomics education program.Evaluation. An 11-question, multiple-choice, electronic survey instrument was distributed to 272 eligible pharmacists at a single campus of a large, academic healthcare system. Pharmacists improved their pharmacogenomics test scores by 0.7 questions (pretest average 46%; posttest average 53%, p=0.0003).Conclusions. Although pharmacists demonstrated improvement, overall retention of educational goals and objectives was marginal. These results suggest that the complex topic of pharmacogenomics requires a large educational effort in order to increase pharmacists' knowledge and comfort level with this emerging therapeutic opportunity.
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McCullough KB, Formea CM, Berg KD, Burzynski JA, Cunningham JL, Ou NN, Rudis MI, Stollings JL, Nicholson WT. Assessment of the pharmacogenomics educational needs of pharmacists. Am J Pharm Educ 2011; 75:51. [PMID: 21655405 PMCID: PMC3109805 DOI: 10.5688/ajpe75351] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 12/06/2010] [Indexed: 05/09/2023]
Abstract
OBJECTIVES To evaluate the self-perceived knowledge and confidence of inpatient and outpatient pharmacists in applying pharmacogenomics information to clinical practice. METHODS A 19-question multiple-choice, electronic needs-assessment survey instrument was distributed to 480 inpatient and outpatient pharmacists in a large, academic, multi-campus healthcare system. RESULTS The survey response rate was 64% (303). Most respondents (85%) agreed that pharmacists should be required to be knowledgeable about pharmacogenomics, and 65% agreed that pharmacists should be capable of providing information on the appropriate use of pharmacogenomics testing. Sixty-three percent felt they could not accurately apply the results of pharmacogenomics tests to drug-therapy selection, dosing, or monitoring. CONCLUSION Pharmacists believe pharmacogenomics knowledge is important to the profession, but they lack the knowledge and self-confidence to act on the results of pharmacogenomics testing and may benefit from pharmacogenomics education.
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Formea CM, Picha AF, Griffin MG, Schaller JA, Lee MR. Enhancing participant safety through electronically generated medication order sets in a clinical research environment: a medical informatics initiative. Clin Transl Sci 2010; 3:312-5. [PMID: 21167008 DOI: 10.1111/j.1752-8062.2010.00240.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
While clinical medicine is often well supported by health system information technology infrastructure, clinical research may need to create strategies to use clinical-medicine informational technology tools. The authors describe a medication-safety initiative that was carried out in a National Institutes of Health Clinical and Translational Science Award (CTSA)-sponsored clinical research environment. A web based, medical informatics application was designed and implemented that allowed research groups to build protocol specific, electronic medication templates that were subsequently used to create participant-specific medication order sets for conductance of clinical research activities in the CTSA-sponsored clinical research environment. The medical informatics initiative eliminated typewritten or handwritten medication orders, created research protocol-specific templates meeting institutional order-writing requirements, and formalized a rigorous review and approval process. Enhancing safety in medication ordering and prescribing practices in a clinical research environment provided the background for multidisciplinary cooperation in medical informatics.
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Affiliation(s)
- Christine M Formea
- Hospital Pharmacy Services, Mayo Clinic, St. Marys Hospital, Rochester, Minnesota, USA.
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Cavallari LH, Overholser BR, Anderson D, Boyce E, Buie L, Formea CM, Gallagher JC, Hayney MS, Oestreich J. Recommended Basic Science Foundation Necessary to Prepare Pharmacists to Manage Personalized Pharmacotherapy. Pharmacotherapy 2010. [DOI: 10.1592/phco.30.6.626] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Formea CM, Griffin MG, Picha AF, Schaller JA, Lee MR. Electronic Forms in a Hospital and Hospital-Based Outpatient Clinical Research Environment to Maximize Patient Safety. Hosp Pharm 2009. [DOI: 10.1310/hpj4406-522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patient safety is a complex issue that is constantly evolving. Communication via standardized drug ordering is recognized as one of the key elements for providing a safer hospital stay, as well as a stronger patient outcome. This feature provides examples of standardized drug prescribing and a forum for discussion. If you have a template that you believe may be beneficial to other hospital pharmacies, please submit it along with answers to the questions (as shown in the text of this article) to Joyce Generali, Director of Drug Information, Kansas University Medical Center, 3901 Rainbow Boulevard, Mail Stop 4040, Kansas City, KS 66160 or e-mail jgeneral@kumc.edu .
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Affiliation(s)
| | - Monica G. Griffin
- Medication Safety and Compliance Pharmacist, Pharmacy Services, Mayo Clinic
| | | | - Jane A. Schaller
- Nursing Education Specialist, CTSA Research Resources, Mayo Clinic
| | - Mary R. Lee
- Systems and Procedures, Mayo Clinic, Rochester, Minnesota
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Formea CM, Weiss WT, McCluskey SV. A collaborative effort to comply with USP chapter 797 for compounding sterile preparations for investigational use. Am J Health Syst Pharm 2008; 65:1266-9. [PMID: 18574018 DOI: 10.2146/ajhp070497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A collaborative effort between two pharmacy specialty areas for ensuring compliance with United States Pharmacopeia (USP) chapter 797 for compounded sterile preparations (CSPs) is described. SUMMARY In September 2005, an investigational drug service (IDS) satellite was opened at a 1157-bed, level 1 trauma, academic hospital in Minnesota. After construction of the IDS satellite, a collaborative consulting service was established between the two pharmacy areas. Protocol-specific investigational medications requiring extemporaneous compounding were reviewed by both an IDS pharmacist and a hospital compounding pharmacist to provide recommendations to investigators. High-risk compounding was performed by the hospital compounding pharmacy, and patient-specific, medium- and low-risk compounding of CSP doses was performed by IDS pharmacy personnel for research participants. A small subset of investigational medications met high-risk criteria and was referred to the hospital compounding pharmacy. After final clearance from quarantine, the high-risk preparations were transferred to the inpatient IDS satellite for dispensing of patient-specific investigational medication doses. The compounding pharmacy followed standardized quality-assurance procedures to ensure sterility, purity, and endotoxin appropriateness for the investigational medications. Quality control of investigational CSPs was maintained by hand delivery of the investigational medication and documentation and disposition via hard-copy receipt on the nursing units. Based on chapter 797 requirements, the department of pharmacy's education and training changed to reflect the new compounding requirements for CSPs, including 20 hours of didactic training for aseptic manipulation skills and practical assessments of aseptic technique using growth media. CONCLUSION A collaborative effort between two specialty areas of pharmacy services ensured compliance with USP chapter 797 requirements for compounded sterile preparations.
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Affiliation(s)
- Christine M Formea
- Saint Marys Hospital Pharmacy, Mayo Clinic Rochester, Rochester, MN 55905, USA.
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Abstract
A 19-year-old woman was admitted to receive a kidney transplant from a nonliving donor. At the time of transplantation, she was taking oral phenytoin 300 mg every morning, 100 mg at noon, and 300 mg every evening (total of 700 mg/day) to treat seizures secondary to hemodialysis. Immediately after the transplantation, phenytoin treatment was resumed, and immunosuppressive therapy consisting of antithymocyte globulin, cyclosporine, mycophenolate mofetil, and corticosteroids was started. Her cyclosporine blood levels varied over the first 10 days after transplantation. Cyclosporine was discontinued, and tacrolimus was begun after acute rejection was discovered. The rejection was treated with antithymocyte globulin, plasmapheresis, and intravenous immunoglobulin, and subsequently resolved; however, the patient's blood concentrations of tacrolimus varied widely. Phenytoin is an antiepileptic drug that induces hepatic enzymes, affecting the cytochrome P450 3A family. These enzymes metabolize approximately 50% of all prescribed drugs, including cyclosporine and tacrolimus. According to the Naranjo adverse drug reaction probability scale, this patient's adverse drug reaction probably occurred from altered metabolism of cyclosporine and tacrolimus due to phenytoin therapy. Clinicians must identify drug interactions between metabolic enzyme inducers or inhibitors and drug substrates with narrow therapeutic ranges, closely monitor drug concentrations, and observe patients for clinical signs and symptoms of therapeutic failure or toxicity. In daily practice, clinicians should explore the metabolic characteristics of drugs and their biotransformation pathways to identify patients who require alternative therapy.
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Affiliation(s)
- Christine M Formea
- Department of Pharmacy Practice, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
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Formea CM, Myers-Huentelman H, Wu R, Crabtree J, Fujita S, Hemming A, Reed A, Howard R, Karlix JL. Thiopurine S-methyltransferase genotype predicts azathioprine-induced myelotoxicity in kidney transplant recipients. Am J Transplant 2004; 4:1810-7. [PMID: 15476481 DOI: 10.1111/j.1600-6143.2004.00575.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Azathioprine (AZA) is an immunosuppressive prodrug that undergoes metabolism by thiopurine S-methyltransferase (TPMT). Eighty to ninety-five percent of low or deficient TPMT enzyme activity is genetically determined by the presence of three nonfunctional mutant alleles: TPMT*2, TPMT*3A and TPMT*3C. Using TPMT as a pharmacogenetic paradigm, we explored the association between these genetic mutations and development of adverse drug effects in an ethnically diverse renal transplant population receiving azathioprine. Biochemical and clinical data were retrospectively evaluated during the first four weeks after kidney transplantation. TPMT nonfunctional mutant alleles were identified by polymerase chain reaction-based methods. Of 89 patients initially consented, 36 met inclusion criteria for this retrospective study. Five patients possessing a single TPMT nonfunctional mutant allele were identified: TPMT*3A: n = 2 Caucasians; TPMT*3B: n = 1 Caucasian; TPMT*3C: n = 2 African-Americans. TPMT nonfunctional mutant alleles were associated with significant reductions in hematological indices and a significant increase in cyclosporine plasma concentrations in the first month post-transplant. TPMT genotype was an independent predictor for hemoglobin, hematocrit and red blood cell changes while mean azathioprine dose (mg/kg/day), azathioprine dose (mg/kg/day) at day 30 and cyclosporinemia at day 30 were not. Prospective application of pharmacogenetic principles may assist in optimization of immunosuppressive drug therapy and minimize drug toxicities.
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Affiliation(s)
- Christine M Formea
- College of Pharmacy, Department of Nephrology, University of Florida, Gainesville, Florida, USA.
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Abstract
Brain injured patients may exhibit altered gastric emptying; thus, some believe post-pyloric feeding to be tolerated better than gastric feeding. Reliable post-pylorus access can be difficult to obtain, so gastric feeding remains the preferred route for administering nutrition. Feeding intolerance may be associated with increased complications and costs. We sought to compare bolus (B) versus continuous (C) gastric feeding in brain injured patients. This retrospective cohort study was carried out at a neurological/neurosurgical intensive care unit at a Level 1 trauma and tertiary referral center. Our subjects were 152 consecutive patients over two years. Use of B or C feedings was based on clinicians' preferences. Abdominal examination and gastric residuals (> 75 mL over four hours) defined feeding intolerance (FI). Putative risks for FI were compared between the groups. Demographic characteristics were similar between groups B (n = 86) and C (n = 66). Feeding intolerance occurred more often in group B than in group C (60.5% vs. 37.9%, p = 0.009). Group C patients achieved 75% of nutritional goals faster than group B patients (median 3.3 vs. 4.6 days; p = 0.03). Prokinetic agent use was similar between the groups and did not reduce the time to achieve nutritional goals. There was a trend towards a reduction in the incidence of infections in group C (p = 0.05). Independent predictors of FI included: sucralfate (OR 2.3), propofol (OR 2.1), pentobarbital (OR 3.9) or paralytic (OR 3) use; older age (OR 5); days receiving mechanical ventilation (OR 1.2); and admission diagnosis of either intracerebral hemorrhage (OR 2.2) or ischemic stroke (OR 1.9). Continuous gastric feeding is better tolerated than B feedings in patients with acute brain injuries. Use of prokinetic agents did not affect time to achievement of nutritional goals. Use of common medications including sucralfate and propofol were associated with FI.
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