Applicability of pharmacogenomically guided medication treatment during hospitalization of at-risk minority patients

Loren Saulsberry*, Keith Danahey, Merisa Middlestadt, Kevin J. O’leary, Edith A. Nutescu, Thomas Chen, James C. Lee, Gregory W. Ruhnke, David George, Larry House, Xander M.R. van Wijk, Kiang Teck J. Yeo, Anish Choksi, Seth W. Hartman, Randall W. Knoebel, Paula N. Friedman, Luke V. Rasmussen, Mark J. Ratain, Minoli A. Perera, David O. MeltzerPeter H. O’donnell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Known disparities exist in the availability of pharmacogenomic information for minority populations, amplifying uncertainty around clinical utility for these groups. We conducted a multi-site inpatient pharmacogenomic implementation program among self-identified African-Americans (AA; n = 135) with numerous rehospitalizations (n = 341) from 2017 to 2020 (NIH-funded ACCOuNT project/clinicaltrials.gov#NCT03225820). We evaluated the point-of-care availability of patient pharmacogenomic results to healthcare providers via an electronic clinical decision support tool. Among newly added medications during hospitalizations and at discharge, we examined the most frequently utilized medications with associated pharmacogenomic results. The population was predominantly female (61%) with a mean age of 53 years (range 19–86). On average, six medications were newly prescribed during each individual hospital admission. For 48% of all hospitalizations, clinical pharmacogenomic information was applicable to at least one newly prescribed medication. Most results indicated genomic favorability, although nearly 29% of newly prescribed medications indicated increased genomic caution (increase in toxicity risk/suboptimal response). More than one of every five medications prescribed to AA patients at hospital discharge were associated with cautionary pharmacogenomic results (most commonly pantoprazole/suboptimal antacid effect). Notably, high-risk pharmacogenomic results (genomic contraindication) were exceedingly rare. We conclude that the applicability of pharmacogenomic information during hospitalizations for vulner-able populations at-risk for experiencing health disparities is substantial and warrants continued prospective investigation.

Original languageEnglish (US)
Article number1343
JournalJournal of Personalized Medicine
Volume11
Issue number12
DOIs
StatePublished - Dec 2021

Keywords

  • Implementation
  • Minority populations
  • Pharmacogenomics

ASJC Scopus subject areas

  • Medicine (miscellaneous)

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