Multi-site investigation of strategies for the clinical implementation of CYP2D6 genotyping to guide drug prescribing.
PURPOSE
A number of institutions have clinically implemented CYP2D6 genotyping to guide drug prescribing. We compared implementation strategies of early adopters of CYP2D6 testing, barriers faced by both early adopters and institutions in the process of implementing CYP2D6 testing, and approaches taken to overcome these barriers.


METHODS
We surveyed eight early adopters of CYP2D6 genotyping and eight institutions in the process of adoption. Data were collected on testing approaches, return of results procedures, applications of genotype results, challenges faced, and lessons learned.


RESULTS
Among early adopters, CYP2D6 testing was most commonly ordered to assist with opioid and antidepressant prescribing. Key differences among programs included test ordering and genotyping approaches, result reporting, and clinical decision support. However, all sites tested for copy-number variation and nine common variants, and reported results in the medical record. Most sites provided automatic consultation and had designated personnel to assist with genotype-informed therapy recommendations. Primary challenges were related to stakeholder support, CYP2D6 gene complexity, phenotype assignment, and sustainability.


CONCLUSION
There are specific challenges unique to CYP2D6 testing given the complexity of the gene and its relevance to multiple medications. Consensus lessons learned may guide those interested in pursuing similar clinical pharmacogenetic programs.
['Cavallari|Larisa H|LH|', 'Van Driest|Sara L|SL|', 'Prows|Cynthia A|CA|', 'Bishop|Jeffrey R|JR|', 'Limdi|Nita A|NA|', 'Pratt|Victoria M|VM|', 'Ramsey|Laura B|LB|', 'Smith|D Max|DM|', 'Tuteja|Sony|S|', 'Duong|Benjamin Q|BQ|', 'Hicks|J Kevin|JK|', 'Lee|James C|JC|', 'Obeng|Aniwaa Owusu|AO|', 'Beitelshees|Amber L|AL|', 'Bell|Gillian C|GC|', 'Blake|Kathryn|K|', 'Crona|Daniel J|DJ|', 'Dressler|Lynn|L|', 'Gregg|Ryan A|RA|', 'Hines|Lindsay J|LJ|', 'Scott|Stuart A|SA|', 'Shelton|Richard C|RC|', 'Weitzel|Kristin Wiisanen|KW|', 'Johnson|Julie A|JA|', 'Peterson|Josh F|JF|', 'Empey|Philip E|PE|', 'Skaar|Todd C|TC|', '|||']
D019389:Cytochrome P-450 CYP2D6 D020000:Decision Support Systems, Clinical D011307:Drug Prescriptions D005820:Genetic Testing D005838:Genotype D006801:Humans D010597:Pharmacogenetics D000071185:Pharmacogenomic Testing D010641:Phenotype
implementation CYP2D6 opioids antidepressants pharmacogenetics