Warfarin Pharmacogenomics in Diverse Populations

Genotype‐guided warfarin dosing algorithms are a rational approach to optimize warfarin dosing and potentially reduce adverse drug events. Diverse populations, such as African Americans and Latinos, have greater variability in warfarin dose requirements and are at greater risk for experiencing warfa...

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Bibliographic Details
Published in:Pharmacotherapy 2017-09, Vol.37 (9), p.1150-1163
Main Authors: Kaye, Justin B., Schultz, Lauren E., Steiner, Heidi E., Kittles, Rick A., Cavallari, Larisa H., Karnes, Jason H.
Format: Article
Language:English
Subjects:
Algorithms
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
anticoagulation
Clinical trials
diversity
Drug dosages
Ethnicity
Ethnicity - genetics
Genotype & phenotype
Humans
Minority & ethnic groups
Pharmacogenetics - methods
Pharmacogenetics - trends
Pharmacogenomic Variants - drug effects
Pharmacogenomic Variants - genetics
Pharmacogenomics
Polymorphism, Single Nucleotide - genetics
Warfarin
Warfarin - adverse effects
Warfarin - therapeutic use
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Summary:Genotype‐guided warfarin dosing algorithms are a rational approach to optimize warfarin dosing and potentially reduce adverse drug events. Diverse populations, such as African Americans and Latinos, have greater variability in warfarin dose requirements and are at greater risk for experiencing warfarin‐related adverse events compared with individuals of European ancestry. Although these data suggest that patients of diverse populations may benefit from improved warfarin dose estimation, the vast majority of literature on genotype‐guided warfarin dosing, including data from prospective randomized trials, is in populations of European ancestry. Despite differing frequencies of variants by race/ethnicity, most evidence in diverse populations evaluates variants that are most common in populations of European ancestry. Algorithms that do not include variants important across race/ethnic groups are unlikely to benefit diverse populations. In some race/ethnic groups, development of race‐specific or admixture‐based algorithms may facilitate improved genotype‐guided warfarin dosing algorithms above and beyond that seen in individuals of European ancestry. These observations should be considered in the interpretation of literature evaluating the clinical utility of genotype‐guided warfarin dosing. Careful consideration of race/ethnicity and additional evidence focused on improving warfarin dosing algorithms across race/ethnic groups will be necessary for successful clinical implementation of warfarin pharmacogenomics. The evidence for warfarin pharmacogenomics has a broad significance for pharmacogenomic testing, emphasizing the consideration of race/ethnicity in discovery of gene–drug pairs and development of clinical recommendations for pharmacogenetic testing.
ISSN:0277-0008
1875-9114
DOI:10.1002/phar.1982