Pre-emptive pharmacogenomics testing in clinical practice: A pilot implementation in Singapore

Pre-emptive genotyping of 16 pharmacogenes integrated into the electronic health record, with clinical decision support for 31 drug-gene pairs

This prospective multicentre pilot assessed the feasibility of pre-emptive pharmacogenomic testing in Singapore. All 2,492 participants genotyped for 16 pharmacogenes carried at least one actionable variant (median 5, range 1-11). Across four institutions, 1,046 of 2,238 patients (46.7%) were prescribed at least one drug with a pharmacogenetic association, and 460 of those (44%) had genotypes linked to undesirable drug responses. Of 285 interruptive decision-support alerts, 69 (24.2%) led to a prescription change, with higher acceptance for new prescriptions (50.0% vs 17.3%), in outpatient settings (31.0% vs 7.3%) and among consultants (57.1%). The authors conclude that the approach is feasible, provided leadership support, robust informatics and sustainable funding are in place.

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

The meaningful figure here is not the proportion of carriers of actionable variants, expected to approach 100%, but the alert acceptance rate: fewer than a quarter of interruptive alerts changed a prescription, and the effect collapses for treatments already under way. This is a documented pre-emptive implementation in a Southeast Asian population, where allele distribution differs markedly from the European cohorts that shaped the model. The limitation lies in the endpoint: the study measures prescribing change, not a reduction in serious adverse drug reactions.

Analysis by Dr Thibaut Benquey