Abstract
Despite the nationwide availability of pharmacogenomic (PGx) guidelines in electronic medication surveillance systems in The Netherlands, PGx guided prescribing is still uncommon in primary care. We set out to investigate the adoption of pharmacist initiated PGx testing in primary care. Community pharmacists were offered a free PGx test covering 40 variants in 8 genes to test patients receiving an incident prescription (IRx) of a selection of 10 drugs. Results of the PGx test along with predicted phenotypes and a therapeutic recommendation based on the Dutch Pharmacogenetics Working Group (DPWG) guidelines were transferred to the pharmacist and physician. Adoption was defined as the percentage of eligible patients that received genotyping. From November 2014–July 2016, 200 patients were included with an adoption of 18.0%. Of the included patients 57.5% received an IRx for atorvastatin, 14.5% started with simvastatin and 28.0% received an IRx for amitriptyline, (es)citalopram, nortriptyline, or venlafaxine. 90% of the patients carried at least one actionable PGx test result in the selected PGx-panel. In 31.0% of the incident prescriptions a combination between a drug with a known gene-drug interaction and an actionable genotype was present and a therapeutic recommendation was provided. The provided recommendations were accepted by the clinicians in 88.7% of the patients. Pharmacist initiated implementation of PGx in primary care is feasible, and the frequency of actionable gene-drug interactions for the selected drugs is high.
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Acknowledgements
We would like to thank V. Rabiea for her assistance in the collection of the follow-up data. This study makes use of data generated by the Genome of the Netherlands (GoNl) Project and the Genome Aggregation Database (gnomAD). A full list of the investigators of the Genome of the Netherlands Project is available from http://www.nlgenome.nl. Funding for the GoNl project was provided by the Netherlands Organization for Scientific Research under award number 184021007, dated 9 July 2009 and made available as a Rainbow Project of the Biobanking and Biomolecular Research Infrastructure Netherlands (BBMRI-NL). The sequencing of samples included in the GoNl project was carried out in collaboration with the Beijing Institute for Genomics (BGI). Additionally, the authors would like to thank the Genome Aggregation Database (gnomAD) and the groups that provided exome and genome variant data to this resource. A full list of contributing groups can be found at https://gnomad.broadinstitute.org/about. This work was supported by unrestricted grants from The Royal Dutch Pharmacist’s Association, The Hague (KNMP), The Netherlands and Zorg & Zekerheid, Leiden, The Netherlands.
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Bank, P.C.D., Swen, J.J., Schaap, R.D. et al. A pilot study of the implementation of pharmacogenomic pharmacist initiated pre-emptive testing in primary care. Eur J Hum Genet 27, 1532–1541 (2019). https://doi.org/10.1038/s41431-019-0454-x
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DOI: https://doi.org/10.1038/s41431-019-0454-x
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