Evidence for Clinical Implementation of Pharmacogenomics in Cardiac Drugs

Objective: To comprehensively assess the pharmacogenomic evidence of routinely used drugs for clinical utility. Methods: Between January 2, 2011, and May 31, 2013, we assessed 71 drugs by identifying all drug/genetic variant combinations with published clinical pharmacogenomic evidence. Literature supporting each drug/variant pair was assessed for study design and methods, outcomes, statistical significance, and clinical relevance. Proposed clinical summaries were formally scored using a modified AGREE (Appraisal of Guidelines for Research and Evaluation) II instrument, including recommendation for or against guideline implementation. Results: Positive pharmacogenomic findings were identified for 51 of 71 cardiovascular drugs (71.8%), representing 884 unique drug/variant pairs from 597 publications. After analysis for quality and clinical relevance, 92 drug/variant pairs were proposed for translation into clinical summaries, encompassing 23 drugs (32.4% of drugs reviewed). All were recommended for clinical implementation using AGREE II, with mean +/- SD overall quality scores of 5.18 +/- 0.91 (of 7.0; range, 3.67-7.0). Drug guidelines had highest mean +/- SD scores in AGREE II domain 1 (Scope) (91.9 +/- 6.1 of 100) and moderate but still robust mean +/- SD scores in domain 3 (Rigor) (73.1 +/- 11.1), domain 4 (Clarity) (67.8 +/- 12.5), and domain 5 (Applicability) (65.8 +/- 10.0). Clopidogrel (CYP2C19), metoprolol (CYP2D6), simvastatin (rs4149056), dabigatran (rs2244613), hydralazine (rs1799983, rs1799998), and warfarin (CYP2C9/VKORC1) were distinguished by the highest scores. Seven of the 9 most commonly prescribed drugs warranted translation guidelines summarizing clinical pharmacogenomic information. Conclusion: Considerable clinically actionable pharmacogenomic information for cardiovascular drugs exists, supporting the idea that consideration of such information when prescribing is warranted. (C) 2015 Mayo Foundation for Medical Education and Research