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Opportunities for Pharmacogenetic Testing Among Hospitalized Children With Medical Complexity.
Carter McIntire1, Addison Donaher1, Dakota Skinn1
1Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Pharmacogenetic (PGx) testing can help children with medical complexity (CMC). Proton pump inhibitors (PPIs) are common, and testing the CYP2C19 gene is a priority for guiding their use.
Area of Science:
- Pediatric Pharmacology
- Genetics and Genomics
- Complex Care Medicine
Background:
- Children with medical complexity (CMC) often have challenges in assessing drug efficacy and adverse events.
- Pharmacogenetic (PGx) testing offers a potential solution for optimizing medication management in CMC.
Purpose of the Study:
- To determine the prevalence of medications with high-level evidence for PGx-guided dosing among CMC.
- To identify key genes associated with these medications for targeted PGx testing.
Main Methods:
- A cross-sectional study of inpatients discharged from a complex care team (June 2019-June 2020).
- Identification of Clinical Pharmacogenetics Implementation Consortium (CPIC) level A medications.
- Comparison with a secondary dataset of patients from a complex care clinic.
Main Results:
- Over 60% of inpatients were prescribed at least one scheduled or PRN CPIC level A medication.
- Proton pump inhibitors (PPIs) like lansoprazole and omeprazole were common scheduled medications.
- CYP2C19, CYP2C9, and CYP2D6 were the most frequently associated genes with prescribed medications.
Conclusions:
- Proton pump inhibitors (PPIs) are frequently prescribed among CMC and are metabolized by CYP2C19.
- CYP2C19 is the most highly implicated gene, suggesting it should be a priority for PGx testing in this population.
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