Clinical Utility of Pharmacogenomic Data Collected by a Health-System Biobank to Predict and Prevent Adverse Drug Events

Sonam N. Shah (), Roseann S. Gammal, Mary G. Amato, Maryam Alobaidly, Dariel Delos Reyes, Sarah Hasan, Diane L. Seger, Joel B. Krier and David W. Bates
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Sonam N. Shah: Brigham and Women’s Hospital
Roseann S. Gammal: MCPHS University School of Pharmacy
Mary G. Amato: Brigham and Women’s Hospital
Maryam Alobaidly: MCPHS University School of Pharmacy
Dariel Delos Reyes: MCPHS University School of Pharmacy
Sarah Hasan: MCPHS University School of Pharmacy
Diane L. Seger: Partners Healthcare
Joel B. Krier: Brigham and Women’s Hospital
David W. Bates: Brigham and Women’s Hospital

Drug Safety, 2021, vol. 44, issue 5, No 9, 607 pages

Abstract: Abstract Introduction Medication-related harm represents a significant issue for patient safety and quality of care. One strategy to avoid preventable adverse drug events is to utilize patient-specific factors such as pharmacogenomics (PGx) to individualize therapy. Objective We measured the number of patients enrolled in a health-system biobank with actionable PGx results who received relevant medications and assessed the incidence of adverse drug events (ADEs) that might have been prevented had the PGx results been used to inform prescribing. Methods Patients with actionable PGx results in the following four genes with Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines were identified: HLA-A*31:01, HLA-B*15:02, TPMT, and VKORC1. The patients who received interacting medications (carbamazepine, oxcarbazepine, thiopurines, or warfarin) were identified, and electronic health records were reviewed to determine the incidence of potentially preventable ADEs. Results Of 36,424 patients with PGx results, 2327 (6.4%) were HLA-A*31:01 positive; 3543 (9.7%) were HLA-B*15:02 positive; 2893 (7.9%) were TPMT intermediate metabolizers; and 4249 (11.7%) were homozygous for the VKORC1 c.1639 G>A variant. Among patients positive for one of the HLA variants who received carbamazepine or oxcarbazepine (n = 92), four (4.3%) experienced a rash that warranted drug discontinuation. Among the TPMT intermediate metabolizers who received a thiopurine (n = 56), 11 (19.6%) experienced severe myelosuppression that warranted drug discontinuation. Among patients homozygous for the VKORC1 c.1639 G>A variant who received warfarin (n = 379), 85 (22.4%) experienced active bleeding and/or international normalized ratio (INR) > 5 that warranted drug discontinuation or dose reduction. Conclusion Patients with actionable PGx results from a health-system biobank who received relevant medications experienced predictable ADEs. These ADEs may have been prevented if the patients’ PGx results were available in the electronic health record with clinical decision support prior to prescribing.

Date: 2021
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DOI: 10.1007/s40264-021-01050-6

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