Genotyping for Personalized Medicine -- A Look at the PREDICT Initiative

Background: Cytochrome P450 proteins are a large superfamily of metabolically active proteins that include the CYP2C subfamily that is involved in drug metabolism of roughly 20% of prescribed medications. Thirty-four genetic polymorphisms in CYP2C19 and 42 in CYP2C9 include many with a known clinically significant impact on efficacy and adverse drug effects. Patients who are homozygous for mutation CYP2C19*2 are poor metabolizers of clopidogrel (Plavix) resulting in a reduced antiplatelet effect and associated with a U.S. Food and Drug Administration recommendation for alternate drug therapy. Objective: To incorporate prospective genotyping of patients undergoing cardiac stenting into their electronic medical record for the purpose of guiding antiplatelet drug selection. Methods: Multiple divisions within Vanderbilt University, including ethics and pharmacy and therapeutics committees, thoroughly investigated and planned implementation of the Pharmacogenomic Resource for Enhanced Dec more...