Multi-site investigation of strategies for the clinical implementation of CYP2D6 genotyping to guide drug prescribing

on behalf of the IGNITE Network

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: A number of institutions have clinically implemented CYP2D6 genotyping to guide drug prescribing. We compared implementation strategies of early adopters of CYP2D6 testing, barriers faced by both early adopters and institutions in the process of implementing CYP2D6 testing, and approaches taken to overcome these barriers. Methods: We surveyed eight early adopters of CYP2D6 genotyping and eight institutions in the process of adoption. Data were collected on testing approaches, return of results procedures, applications of genotype results, challenges faced, and lessons learned. Results: Among early adopters, CYP2D6 testing was most commonly ordered to assist with opioid and antidepressant prescribing. Key differences among programs included test ordering and genotyping approaches, result reporting, and clinical decision support. However, all sites tested for copy-number variation and nine common variants, and reported results in the medical record. Most sites provided automatic consultation and had designated personnel to assist with genotype-informed therapy recommendations. Primary challenges were related to stakeholder support, CYP2D6 gene complexity, phenotype assignment, and sustainability. Conclusion: There are specific challenges unique to CYP2D6 testing given the complexity of the gene and its relevance to multiple medications. Consensus lessons learned may guide those interested in pursuing similar clinical pharmacogenetic programs.

Original languageEnglish (US)
JournalGenetics in Medicine
DOIs
StatePublished - Jan 1 2019

Fingerprint

Drug Prescriptions
Cytochrome P-450 CYP2D6
Genotype
Clinical Decision Support Systems
Pharmacogenetics
Opioid Analgesics
Antidepressive Agents
Genes
Medical Records
Referral and Consultation
Phenotype

Keywords

  • antidepressants
  • CYP2D6
  • implementation
  • opioids
  • pharmacogenetics

ASJC Scopus subject areas

  • Genetics(clinical)

Cite this

Multi-site investigation of strategies for the clinical implementation of CYP2D6 genotyping to guide drug prescribing. / on behalf of the IGNITE Network.

In: Genetics in Medicine, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Multi-site investigation of strategies for the clinical implementation of CYP2D6 genotyping to guide drug prescribing",
abstract = "Purpose: A number of institutions have clinically implemented CYP2D6 genotyping to guide drug prescribing. We compared implementation strategies of early adopters of CYP2D6 testing, barriers faced by both early adopters and institutions in the process of implementing CYP2D6 testing, and approaches taken to overcome these barriers. Methods: We surveyed eight early adopters of CYP2D6 genotyping and eight institutions in the process of adoption. Data were collected on testing approaches, return of results procedures, applications of genotype results, challenges faced, and lessons learned. Results: Among early adopters, CYP2D6 testing was most commonly ordered to assist with opioid and antidepressant prescribing. Key differences among programs included test ordering and genotyping approaches, result reporting, and clinical decision support. However, all sites tested for copy-number variation and nine common variants, and reported results in the medical record. Most sites provided automatic consultation and had designated personnel to assist with genotype-informed therapy recommendations. Primary challenges were related to stakeholder support, CYP2D6 gene complexity, phenotype assignment, and sustainability. Conclusion: There are specific challenges unique to CYP2D6 testing given the complexity of the gene and its relevance to multiple medications. Consensus lessons learned may guide those interested in pursuing similar clinical pharmacogenetic programs.",
keywords = "antidepressants, CYP2D6, implementation, opioids, pharmacogenetics",
author = "{on behalf of the IGNITE Network} and Cavallari, {Larisa H.} and {Van Driest}, {Sara L.} and Prows, {Cynthia A.} and Bishop, {Jeffrey R.} and Limdi, {Nita A.} and Pratt, {Victoria M.} and Ramsey, {Laura B.} and Smith, {D. Max} and Sony Tuteja and Duong, {Benjamin Q.} and Hicks, {J. Kevin} and Lee, {James C.} and Obeng, {Aniwaa Owusu} and Beitelshees, {Amber L.} and Bell, {Gillian C.} and Kathryn Blake and Crona, {Daniel J.} and Lynn Dressler and Gregg, {Ryan A.} and Hines, {Lindsay J.} and Scott, {Stuart A.} and Shelton, {Richard C.} and Weitzel, {Kristin Wiisanen} and Johnson, {Julie A.} and Peterson, {Josh F.} and Empey, {Philip E.} and Todd Skaar",
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AU - on behalf of the IGNITE Network

AU - Cavallari, Larisa H.

AU - Van Driest, Sara L.

AU - Prows, Cynthia A.

AU - Bishop, Jeffrey R.

AU - Limdi, Nita A.

AU - Pratt, Victoria M.

AU - Ramsey, Laura B.

AU - Smith, D. Max

AU - Tuteja, Sony

AU - Duong, Benjamin Q.

AU - Hicks, J. Kevin

AU - Lee, James C.

AU - Obeng, Aniwaa Owusu

AU - Beitelshees, Amber L.

AU - Bell, Gillian C.

AU - Blake, Kathryn

AU - Crona, Daniel J.

AU - Dressler, Lynn

AU - Gregg, Ryan A.

AU - Hines, Lindsay J.

AU - Scott, Stuart A.

AU - Shelton, Richard C.

AU - Weitzel, Kristin Wiisanen

AU - Johnson, Julie A.

AU - Peterson, Josh F.

AU - Empey, Philip E.

AU - Skaar, Todd

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N2 - Purpose: A number of institutions have clinically implemented CYP2D6 genotyping to guide drug prescribing. We compared implementation strategies of early adopters of CYP2D6 testing, barriers faced by both early adopters and institutions in the process of implementing CYP2D6 testing, and approaches taken to overcome these barriers. Methods: We surveyed eight early adopters of CYP2D6 genotyping and eight institutions in the process of adoption. Data were collected on testing approaches, return of results procedures, applications of genotype results, challenges faced, and lessons learned. Results: Among early adopters, CYP2D6 testing was most commonly ordered to assist with opioid and antidepressant prescribing. Key differences among programs included test ordering and genotyping approaches, result reporting, and clinical decision support. However, all sites tested for copy-number variation and nine common variants, and reported results in the medical record. Most sites provided automatic consultation and had designated personnel to assist with genotype-informed therapy recommendations. Primary challenges were related to stakeholder support, CYP2D6 gene complexity, phenotype assignment, and sustainability. Conclusion: There are specific challenges unique to CYP2D6 testing given the complexity of the gene and its relevance to multiple medications. Consensus lessons learned may guide those interested in pursuing similar clinical pharmacogenetic programs.

AB - Purpose: A number of institutions have clinically implemented CYP2D6 genotyping to guide drug prescribing. We compared implementation strategies of early adopters of CYP2D6 testing, barriers faced by both early adopters and institutions in the process of implementing CYP2D6 testing, and approaches taken to overcome these barriers. Methods: We surveyed eight early adopters of CYP2D6 genotyping and eight institutions in the process of adoption. Data were collected on testing approaches, return of results procedures, applications of genotype results, challenges faced, and lessons learned. Results: Among early adopters, CYP2D6 testing was most commonly ordered to assist with opioid and antidepressant prescribing. Key differences among programs included test ordering and genotyping approaches, result reporting, and clinical decision support. However, all sites tested for copy-number variation and nine common variants, and reported results in the medical record. Most sites provided automatic consultation and had designated personnel to assist with genotype-informed therapy recommendations. Primary challenges were related to stakeholder support, CYP2D6 gene complexity, phenotype assignment, and sustainability. Conclusion: There are specific challenges unique to CYP2D6 testing given the complexity of the gene and its relevance to multiple medications. Consensus lessons learned may guide those interested in pursuing similar clinical pharmacogenetic programs.

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KW - CYP2D6

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KW - pharmacogenetics

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