Results of the ACCOuNT Trial: A Multi-Institutional Prospective Pharmacogenomics Implementation Trial for African American Inpatients.

Abstract

Pharmacogenomics implementation efforts have increased over the last decade, but no published prospective pharmacogenomics trials have formally evaluated utility in underrepresented populations. We present final results from the ACCOuNT trial, a multi-institutional prospective study [NCT03225820] in which African American inpatients were genotyped and pharmacogenomic results made available via an integrated, scalable pharmacogenomics clinical decision support (PGx CDS) system to guide prescribing. We hypothesized that PGx CDS utilization would improve genomically concordant prescribing during inpatient admissions. We recruited 531 patients, of which 187 were readmitted (60.4% female, median age = 55 [range: 19-88], median readmissions/patient = 2 [range: 1-17]), resulting in 518 evaluable admissions during which the effect of available pharmacogenomic results was measured. In 50% of admissions, care teams utilized PGx CDS. 12% of inpatient prescriptions had pharmacogenomic annotations, with only 3.6% pharmacogenomically associated with increased caution ("discordant"); no PGx high-risk medications were prescribed. PGx CDS use by provider teams did not decrease genomically discordant prescribing (3.9% vs. 3.3% without PGx CDS use, P = 0.53). Nevertheless, inpatient care teams repeatedly consulted PGx CDS ostensibly to affirm genomically concordant prescriptions, as 48% of all admissions and 91% of discharges included pharmacogenomically annotated medications, mostly genomically concordant. Notably, timing of PGx CDS utilization correlated tightly with prescribing timing (correlation coefficient = 0.84, P < 0.05). In the first results of a multi-institutional, prospective pharmacogenomics trial focused on underrepresented patients, we found the relevance of currently actionable pharmacogenomics information for guiding inpatient prescribing to be modest; but observed frequent use of concordant pharmacogenomics to affirm prescribing.