Characterizing Pharmacogenomic-Guided Medication Use With a Clinical Data Repository

Abstract

The extent to which pharmacogenomic-guided medication use has been adopted in various health systems is unclear. To assess the uptake of pharmacogenomic-guided medication use, we determined its frequency across our health system, which does not have a structured testing program. Using a multisite clinical data repository, we identified adult patients' first prescribed medications between January 2011 and December 2013 and investigated the frequency of germline and somatic pharmacogenomic testing, by the Pharmacogenomics Knowledgebase level of the US Food and Drug Administration label information. There were 268,262 medication orders for drugs with germline pharmacogenomic testing information in their drug labels. Pharmacogenomic testing was detected for 1.5% (129/8,718) of medication orders with recommended or required testing. Of the 3,817 medication orders associated with somatic pharmacogenomic testing information in their drug labels, 20% (372/1,819) of required tests were detected. The low rates of detectable pharmacogenomic testing suggest that structured testing programs are required to achieve the success of precision medicine.

Figure 1

a. Time trends in the percentage of index medication orders for which a PGx test was drawn, stratified by PharmGKB level of actionability: Germline tests b. Time trends in the percentage of index medication orders for which a PGx test was drawn, stratified by PharmGKB level of actionability: Somatic tests

Figure 2

a. Distribution of the number of days between a PGx test order and the index medication order: Germline tests b. Distribution of the number of days between a PGx test order and the frequency of index medication order: Somatic tests