Genotype-Guided vs Clinically-Guided Stable Warfarin Dose Prediction and Stable Dose Establishment In A Predominantly Non-European Ancestry Population

IF 1 Q4 PHARMACOLOGY & PHARMACY

Expert Review of Precision Medicine and Drug Development Pub Date : 2021-10-28 DOI:10.1080/23808993.2021.1989303

Annesti F. Elmasri, Hee-soo Hur, Jin Han, James C. Lee

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Abstract

ABSTRACT Background Warfarin dosing varies due to individual genetic and clinical factors. The utility of genotype‐guided warfarin dosing to improve stable warfarin dose is not extensively studied in non-European populations. Research design and methods Retrospective cohort study of patients initiating warfarin receiving genotype (PGx)‐guided or clinically guided dosing. Primary outcomes included dose discordance between estimated dose at discharge and eventual stable dose. Results No significant difference in warfarin dose discordance was observed (PGx: 9.1 ± 8.8 mg/week difference vs. Clinical: 7.9 ± 8.9 mg/week difference; P = 0.446). PGx‐guided dosing did not reduce time to achieve stable dose (1.8 ± 2.5 months vs. 2.1 ± 2.6 months; P = 0.508). Vitamin K intake level did not alter prediction accuracy or time to stable dose (PGx‐predicted: dose difference P = 0.493, time to stable dose P = 0.336; Clinically predicted: dose difference P = 0.145, time to dose INR P = 0.095). Conclusions PGx‐guided warfarin dosing did not improve eventual stable dose discordance or reduce the time to achieve stable dose in this predominantly non‐European cohort. Dietary vitamin K intake level did not impact warfarin dose discordance or time to achieve stable warfarin dose. Additional study is needed to identify populations that best benefit from PGx‐guided warfarin dosing.

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基因型引导与临床引导的主要非欧洲祖先群体中华法林稳定剂量预测和稳定剂量建立

背景华法林的剂量因个体遗传和临床因素而异。在非欧洲人群中，基因型引导华法林剂量提高华法林稳定剂量的效用尚未得到广泛研究。研究设计和方法对接受基因型(PGx)指导或临床指导给药的华法林患者进行回顾性队列研究。主要结局包括出院时估计剂量与最终稳定剂量之间的剂量不一致。结果两组华法林剂量差异无显著性差异(PGx: 9.1±8.8 mg/周差异与临床:7.9±8.9 mg/周差异;P = 0.446)。PGx引导给药并没有缩短达到稳定剂量的时间(1.8±2.5个月vs. 2.1±2.6个月);P = 0.508)。维生素K摄入水平不改变预测准确性或达到稳定剂量所需时间(PGx‐预测:剂量差P = 0.493，达到稳定剂量所需时间P = 0.336;临床预测:剂量差P = 0.145，至剂量时间INR P = 0.095)。结论:PGx引导的华法林给药并没有改善最终的稳定剂量不一致或减少达到稳定剂量的时间。膳食维生素K摄入量水平不影响华法林剂量不一致或达到稳定华法林剂量的时间。需要进一步的研究来确定从PGx引导的华法林剂量中获益最大的人群。

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来源期刊

Expert Review of Precision Medicine and Drug Development PHARMACOLOGY & PHARMACY-

CiteScore

2.30

自引率

0.00%

发文量

期刊介绍： Expert Review of Precision Medicine and Drug Development publishes primarily review articles covering the development and clinical application of medicine to be used in a personalized therapy setting; in addition, the journal also publishes original research and commentary-style articles. In an era where medicine is recognizing that a one-size-fits-all approach is not always appropriate, it has become necessary to identify patients responsive to treatments and treat patient populations using a tailored approach. Areas covered include: Development and application of drugs targeted to specific genotypes and populations, as well as advanced diagnostic technologies and significant biomarkers that aid in this. Clinical trials and case studies within personalized therapy and drug development. Screening, prediction and prevention of disease, prediction of adverse events, treatment monitoring, effects of metabolomics and microbiomics on treatment. Secondary population research, genome-wide association studies, disease–gene association studies, personal genome technologies. Ethical and cost–benefit issues, the impact to healthcare and business infrastructure, and regulatory issues.