Drug Use among Nursing Home Residents in Denmark for Drugs Having Pharmacogenomics Based (PGx) Dosing Guidelines: Potential for Preemptive PGx Testing

Abstract

Background: Polypharmacy is most prevalent among the elderly population and in particular among nursing home residents. The frequency of the use of drugs with pharmacogenomics (PGx)-based dosing guidelines for CYP2D6, CYP2C9, CYP2C19 and SLCO1B1 were measured among nursing home residents in the Capital Region of Denmark as well as drug-drug interactions. The aim was to evaluate the potential of applying PGx-test as a supportive tool in medication reviews.

Methods: Drug use among nursing home residents during 2017-2018 in the Capital Region of Copenhagen, for drugs with PGx-based dosing guidelines available through the PharmGKB website, were measured. Drug-drug interactions were scored in severity by using drug interaction checkers.

Results: The number of residents using drugs with PGx-based actionable dosing guidelines (AG) were 119 out of 141 residents (84.3%). Of these 119 residents, 87 residents used drugs with AG for CYP2C19, 47 residents for CYP2D6, and 42 residents for SLCO1B1. In addition, 30 residents used two drugs with an AG for CYP2C19, and for CYP2D6, it was only seven residents. The most used drugs with AG were clopidogrel (42), pantoprazole (32), simvastatin (30), metoprolol (25), and citalopram (24). The most frequent drug interactions found with warnings were combinations of proton pump inhibitors and clopidogrel underscoring the potential for phenoconversion.

Conclusion: this study clearly showed that the majority of the nursing home residents were exposed to drugs or drug combinations for which there exist PGx-based AG. This indeed supports the notion of accessing and accounting for not only drug-gene but also drug-drug-gene interactions as a supplement to medication review.

Keywords: PGx testing; SLCO1B1; cytochrome P450; drug use; drug–drug interactions; drug–gene interactions; medicine review; nursing homes; pharmacogenomics; polypharmacy.

Figure 1

The ten most used drugs and the number of residents treated. Black columns are drugs with no guidelines and red columns are drugs with AG or N-AG. Proton pump inhibitors (PPI) constituted of pantoprazole (32 residents), lansoprazole (seven residents), omeprazole (three residents) all with AG for CYP2C19, and esomeprazole (three residents) with N-AG. Statins cover simvastatin (30 residents) and atorvastin (12 residents) both with AG for SLCO1B1. Metoprolol has AG, quetiapine has N-AG for CYP2D6, and citalopram has AG for CYP2C19.