Journal
CLINICAL PHARMACOLOGY & THERAPEUTICS
Volume 100, Issue 1, Pages 67-74Publisher
WILEY
DOI: 10.1002/cpt.331
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Funding
- Vanderbilt University
- Centers for Disease Control and Prevention [U47CI000824]
- National Heart, Lung, and Blood Institute [U01HL122904, U01HL105198]
- National Institute for General Medical Sciences [U19HL065962]
- National Human Genome Research Institute [U01HG006378, U01HG007253]
- National Center for Advancing Translational Sciences [UL1TR000445]
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Physician responses to genomic information are vital to the success of precision medicine initiatives. We prospectively studied a pharmacogenomics implementation program for the propensity of clinicians to select antiplatelet therapy based on CYP2C19 loss-of-function variants in stented patients. Among 2,676 patients, 514 (19.2%) were found to have a CYP2C19 variant affecting clopidogrel metabolism. For the majority (93.6%) of the cohort, cardiologists received active and direct notification of CYP2C19 status. Over 12 months, 57.6% of poor metabolizers and 33.2% of intermediate metabolizers received alternatives to clopidogrel. CYP2C19 variant status was the most influential factor impacting the prescribing decision (hazard ratio [HR] in poor metabolizers 8.1, 95% confidence interval [CI] [5.4, 12.2] and HR 5.0, 95% CI [4.0, 6.3] in intermediate metabolizers), followed by patient age and type of stent implanted. We conclude that cardiologists tailored antiplatelet therapy for a minority of patients with a CYP2C19 variant and considered both genomic and nongenomic risks in their clinical decision-making.
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