Advertisement

Preemptive Panel-Based Pharmacogenetic Testing: The Time is Now

Abstract

While recent discoveries have paved the way for the use of genotype-guided prescribing in some clinical environments, significant debate persists among clinicians and researchers about the optimal approach to pharmacogenetic testing in clinical practice. One crucial factor in this debate surrounds the timing and methodology of genotyping, specifically whether genotyping should be performed reactively for targeted genes when a single drug is prescribed, or preemptively using a panel-based approach prior to drug prescribing. While early clinical models that employed a preemptive approach were largely developed in academic health centers through multidisciplinary efforts, increasing examples of pharmacogenetic testing are emerging in community-based and primary care practice environments. However, educational and practice-based resources for these clinicians remain largely nonexistent. As such, there is a need for the health care system to shift its focus from debating about preemptive genotyping to developing and disseminating needed resources to equip frontline clinicians for clinical implementation of pharmacogenetics. Providing tools and guidance to support these emerging models of care will be essential to support the thoughtful, evidence-based use of pharmacogenetic information in diverse clinical practice environments. Specifically, the creation of efficient and accurate point-of-care resources, practice-based tools, and clinical models is needed, along with identification and dissemination of sustainable avenues for pharmacogenetic test reimbursement.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.

References

  1. 1.

    Relling MV, Evans WE. Pharmacogenomics in the clinic. Nature. 2015;526(7573):343–50. doi:10.1038/nature15817.

  2. 2.

    Van Driest SL, Shi Y, Bowton EA, Shildcrout JS, Peterson JF, Pulley J, et al. Clinically actionable genotypes among 10,000 patients with preemptive pharmacogenomic testing. Clin Pharmacol Ther. 2014;95(4):423–31. doi:10.1038/clpt.2013.229.

  3. 3.

    Bell GC, Crews KR, Wilkinson MR, Haidar CE, Hicks JK, Baker DK, et al. Development and use of active clinical decision support for preemptive pharmacogenomics. J Am Med Inform Assoc. 2014;21(e1):e93–9. doi:10.1136/amiajnl-2013-001993.

  4. 4.

    Schildcrout JS, Denny JC, Bowton E, Gregg W, Pulley JM, Basford MA, Cowan JD, Xu H, Ramirez AH, Crawford DC, Ritchie MD, Peterson JF, Masys DR, Wilke RA, Roden DM. Optimizing drug outcomes through pharmacogenetics: a case for preemptive genotyping. Clin Pharmacol Ther. 2012;92(2):235–42. doi:10.1038/clpt.2012.66.

  5. 5.

    Dunnenberger HM, Crews KR, Hoffman JM, Caudle KE, Broeckel U, Howard SC, et al. Preemptive clinical pharmacogenetics implementation: current programs in five US medical centers. Annu Rev Pharmacol Toxicol. 2015;55:89–106. doi:10.1146/annurev-pharmtox-010814-124835.

  6. 6.

    Janssens ACJW, Deverka PA. Useless until proven effective: the clinical utility of preemptive pharmacogenetic testing. Clin Pharmacol Ther. 2014;96(6):652–4. doi:10.1038/clpt.2014.186.

  7. 7.

    Koch BC, van Schaik RH, van Gelder T, Mathijssen RH. Rotterdam Clinical Pharmacology-Pharmacogenetics Group (RCPPG). Doubt about the feasibility of preemptive genotyping. Clin Pharmacol Ther. 2013;93(3):233. doi:10.1038/clpt.2012.191.

  8. 8.

    Caudle KE, Klein TE, Hoffman JM, Whirl-Carrillo M, Gong L, McDonagh EM, et al. Incorporation of pharmacogenomics into routine clinical practice: the clinical pharmacogenetics implementation Consortium (CPIC) guideline development process. Curr Drug Metab. 2014;15(2):209–17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977533/

  9. 9.

    Johnson JA, Burkley BM, Langaee TY, Clare-Salzler MJ, Klein TE, Altman RB. Implementing personalized medicine: development of a cost-effective customized pharmacogenetics genotyping array. Clinical Pharmacol Ther. 2012;92(4):437–9. doi:10.1038/clpt.2012.125.

  10. 10.

    Ferreri SP, Greco AJ, Michaels NM, O'Connor SK, Chater RW, Viera AJ, et al. Implementation of a pharmacogenomics service in a community pharmacy. J Am Pharm Assoc. 2014;54(2):172–80. doi:10.1331/JAPhA.2014.13033.

  11. 11.

    Dawes M, Aloise MN, Ang JS, Cullis P, Dawes D, Fraser R, et al. Introducing pharmacogenetic testing with clinical decision support into primary care: a feasibility study. CMAJ. 2016;4(3):E528–34. doi:10.9778/cmajo.20150070.

  12. 12.

    Haga SB, LaPointe NM, Cho A, Reed SD, Mills R, Moaddeb J, et al. Pilot study of pharmacist-assisted delivery of pharmacogenetic testing in a primary care setting. Pharmacogenomics. 2014;15(13):1677–86. doi:10.2217/pgs.14.109.

  13. 13.

    Mills R, Haga SB. Clinical delivery of pharmacogenetic testing services: a proposed partnership between genetic counselors and pharmacists. Pharmacogenomics. 2013;14(8):957–68. doi:10.2217/pgs.13.76.

  14. 14.

    Dunnenberger HM, Biszewski M, Bell GC, Sereika A, Holley M, Hulick PJ, et al. Implementation of a multidisciplinary pharmacogenomics clinic in a community health system. Am J Health Sys Pharm. 2016;73(23):1956–66. doi:10.2146/ajhp160072.

  15. 15.

    Hicks JK, Dunnenberger HM, Gumpper KF, Haidar CE, Hoffman JM. Integrating pharmacogenomics into electronic health records with clinical decision support. Am J Health Sys Pharm. 2016;73(23):1967–76. doi:10.2146/ajhp160030.

  16. 16.

    Hicks JK, Stowe D, Willner MA, Wai M, Daly T, Gordon SM, et al. Implementation of clinical pharmacogenomics within a large health system: from electronic health record decision support to consultation services. Pharmacotherapy. 2016;36(8):940–8. doi:10.1002/phar.1786.

  17. 17.

    Johansen Taber KA, Dickinson BD. Pharmacogenomic knowledge gaps and educational resource needs among physicians in selected specialties. Pharmgenomics Pers Med. 2014;7:145–62. doi:10.2147/PGPM.S63715.

  18. 18.

    Graf MD, Needham DF, Teed N, Brown T. Genetic testing insurance coverage trends: a review of publicly available policies from the largest US payers. Pers Med. 2013;10(3):235–43. doi:10.2217/pme.13.9.

  19. 19.

    Hefti E, Blanco JG. Documenting pharmacogenetic testing with CPT codes. J AHIMA. 2016;87(1):56–9.

  20. 20.

    Carpenter JS, Rosenman MB, Knisely MR, Decker BS, Levy KD, Flockhart DA. Pharmacogenomically actionable medications in a safety net health care system. SAGE Open Med. 2016;4:2050312115624333. doi:10.1177/2050312115624333.

Download references

Acknowledgments and Disclosures

Funded by NIH grants U01HG007269, UL1TR001427 and institutional support from the University of Florida.

Author information

Correspondence to Kristin W. Weitzel.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Weitzel, K.W., Cavallari, L.H. & Lesko, L.J. Preemptive Panel-Based Pharmacogenetic Testing: The Time is Now. Pharm Res 34, 1551–1555 (2017). https://doi.org/10.1007/s11095-017-2163-x

Download citation

KEY WORDS

  • genomic medicine
  • implementation
  • pharmacogenetic
  • pharmacogenomic
  • preemptive