Dispensing of actionable pharmacogenetic drugs among adults receiving cardiovascular disease medications in the Northern Netherlands: A serial cross-sectional study

Prevalence of exposure to drugs with actionable gene-drug interactions per CPIC or DPWG, and potential for reuse of CYP2C19, CYP2D6 or SLCO1B1 genotyping

Serial cross-sectional study using the University of Groningen IADB.nl community pharmacy database, from 2019 to 2023, covering adults on cardiovascular disease treatment, defined as at least two prescriptions of the same cardiovascular drug within 180 days. Annual cohort size ranged from 47 602 people in 2019 to 41 846 in 2023, with a mean age of about 70 years and 48% men. The prevalence of dispensing at least one drug with an actionable gene-drug interaction per CPIC or DPWG remained stable at around 90%, at least two at 68%, and increased significantly with age. Cardiovascular drugs accounted for 75% of the drugs involved, ahead of proton pump inhibitors (55%); in 2023, drugs associated with CYP2C19, CYP2D6 and SLCO1B1 concerned 60%, 53% and 51% of patients respectively. Among them, 24%, 23% and 4% would have had an opportunity to reuse a single-gene genotyping result, versus 66%, 65% and 83% with panel genotyping.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

The number that matters here is the contrast between 4% and 83% for SLCO1B1: single-gene genotyping, triggered by one prescription, will almost never be reused, whereas a panel performed once covers the large majority of later opportunities. This is the most direct argument for preemptive panel genotyping, quantified here in a real-world population of more than 40 000 treated adults with a mean age of 70, precisely the population in which polypharmacy makes the question relevant. The study measures no clinical outcome and no cost, however: it describes an exposure opportunity, not a benefit, and the health-economic evaluation remains to be done, as the authors acknowledge.

Analysis by Dr Thibaut Benquey