Implementing Pharmacogenomics Testing: Single Center Experience at Arkansas Children's Hospital

Pritmohinder S Gill; Feliciano B Yu; Patricia A Porter-Gill; Bobby L Boyanton; Judy C Allen; Jason E Farrar; Aravindhan Veerapandiyan; Parthak Prodhan; Kevin J Bielamowicz; Elizabeth Sellars; Andrew Burrow; Joshua L Kennedy; Jeffery L Clothier; David L Becton; Don Rule; G Bradley Schaefer

doi:10.3390/jpm11050394

Implementing Pharmacogenomics Testing: Single Center Experience at Arkansas Children's Hospital

J Pers Med. 2021 May 11;11(5):394. doi: 10.3390/jpm11050394.

Authors

Pritmohinder S Gill^{1

2}, Feliciano B Yu³, Patricia A Porter-Gill², Bobby L Boyanton⁴, Judy C Allen⁵, Jason E Farrar^{1

2

6}, Aravindhan Veerapandiyan^{2

7}, Parthak Prodhan^{2

8}, Kevin J Bielamowicz^{1

2

6}, Elizabeth Sellars^{1

2

9}, Andrew Burrow^{1

2

9}, Joshua L Kennedy^{1

2}, Jeffery L Clothier¹⁰, David L Becton^{1

2

6}, Don Rule¹¹, G Bradley Schaefer^{1

2

12}

Affiliations

¹ Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
² Arkansas Children's Research Institute, Little Rock, AR 72202, USA.
³ Pediatrics and Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
⁴ Departments of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR 72202, USA.
⁵ Informatics, Arkansas Children's Hospital, 1 Children's Way #512-10, Little Rock, AR 72202, USA.
⁶ Pediatric Hematology/Oncology, Arkansas Children's Hospital, 1 Children's Way #512-10, Little Rock, AR 72202, USA.
⁷ Pediatric Neurology, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR 72202, USA.
⁸ Pediatric Cardiology, Arkansas Children's Hospital, Little Rock, AR 72202, USA.
⁹ Section of Genetics and Metabolism, Arkansas Children's Hospital, Little Rock, AR 72202, USA.
¹⁰ Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
¹¹ Translational Software, Inc., TSI, Bellevue, WA 98005, USA.
¹² Arkansas Children's Hospital NW, Springdale, AR 72762, USA.

Abstract

Pharmacogenomics (PGx) is a growing field within precision medicine. Testing can help predict adverse events and sub-therapeutic response risks of certain medications. To date, the US FDA lists over 280 drugs which provide biomarker-based dosing guidance for adults and children. At Arkansas Children's Hospital (ACH), a clinical PGx laboratory-based test was developed and implemented to provide guidance on 66 pediatric medications for genotype-guided dosing. This PGx test consists of 174 single nucleotide polymorphisms (SNPs) targeting 23 clinically actionable PGx genes or gene variants. Individual genotypes are processed to provide per-gene discrete results in star-allele and phenotype format. These results are then integrated into EPIC- EHR. Genomic indicators built into EPIC-EHR provide the source for clinical decision support (CDS) for clinicians, providing genotype-guided dosing.

Keywords: best practice alerts (BPAs); clinical decision support (CDS); electronic health records (EHR); genomic indicators; genotype; pediatrics; pharmacogenomics (PGx); phenotype.