Pharmacogenomics is the study of genetic factors governing drug response and toxicity. This field has led to discovery of genetic variants impacting response or toxicity for hundreds of drugs, but the information has infrequently been utilized in prescribing decisions. Implementation has been hampered by questions about the clinical utility of associations, poor physician knowledge about drug-gene relationships, limited avenues for testing, and delays in the receipt of pharmacogenomic results. To address these barriers, the Genomics Prescribing System (GPS) was developed and tested within the1200 Patient?s Project. This proposal is based, in part, on preliminary work that ACCOuNT investigators have undertaken in the area of pharmacogenomic implementation. Specifically, we conducted a single-institution implementation science project aimed at demonstrating the feasibility of establishing and utilizing an individualized health care model of preemptive pharmacogenomic testing with instantaneous pharmacogenomic results delivery and clinical decision support at the point-of-care. In our Translational Project, we hypothesize that prospectively genotyping and incorporating African-American specific genetic variants into clinical care will influence physician-prescribing and therapeutic effectiveness. We will test this hypothesis with the following aims: 1) Incorporate race-specific SNPs and recommendations into GPS for selected cardiovascular medications, 2) Create a cohort of African Americans patients receiving care using GPS guided therapy, and 3) Assess prescribing decisions and clinical outcomes related to racespecific recommendations via GPS within ACCOuNT institutions. Through the infrastructure of ACCOuNT we will conduct our translational efforts with a patient-centered approach that incorporates the input of community partners, frontline physicians and African American patients, who will provide input on relevant clinical phenotypes in this populations. We anticipate that these studies will reveal attitudes of both physician and patient to this novel technology, as well as the benefit to both patients and physicians in terms of clinical outcomes and quality of care received. We will be creating a large repository of hospitalized African American patients that receive GPS guided therapy in which we can: 1) determine highly utilized medications that would benefit from discovery studies, and 2) new translational efforts in drugs in which novel SNPs that predict response are found in the future. In this way, we create an on-going pipeline from discovery to translation and ultimately to implementation.
| De, Tanima; Alarcon, Cristina; Hernandez, Wenndy et al. (2018) Association of Genetic Variants With Warfarin-Associated Bleeding Among Patients of African Descent. JAMA 320:1670-1677 |
| De, Tanima; Park, C Sehwan; Perera, Minoli A (2018) Cardiovascular Pharmacogenomics: Does It Matter If You're Black or White? Annu Rev Pharmacol Toxicol : |
