Journal article
Prevalence of Actionable Pharmacogenetic Genotype Frequencies, Cautionary Medication Use, and Polypharmacy in Community-Dwelling Older Adults
Clinical pharmacology and therapeutics, Vol.118(2), pp.337-342
08/2025
DOI: 10.1002/cpt.3702
PMCID: PMC12272320
PMID: 40304392
Abstract
Older adults (65 years and over) frequently manage complex medication regimens and are vulnerable to adverse drug reactions and treatment inefficacies, some of which could be preventable with pharmacogenetics (PGx)-guided prescribing. This study examined the prevalence of actionable PGx genotypes (i.e., those linked to a guideline that recommends a change to standard prescribing), the use of cautionary medications (i.e., those associated with an actionable PGx genotype), polypharmacy (i.e., ≥ 5 medications simultaneously), and cytochrome P450 enzyme inhibitor and inducer use among 13,670 older adults enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Genotyping was conducted for 10 pharmacogenes with actionable PGx-based prescribing guidelines. Medication data were collected annually and assessed to identify cautionary medication use in the cohort. Most participants (98.8%) carried at least one actionable PGx genotype, with an average of three actionable genotypes per participant. VKORC1 (61.1%) and CYP2C19 (59.6%) were the most frequently observed genes with actionable genotypes. Statins (29.3%), nonsteroidal anti-inflammatory drugs (14.2%), and proton-pump inhibitors (7.9%) were the most used cautionary medications, with 27.5% of participants taking at least one medication for which PGx guidelines recommended a deviation from standard prescribing. Most (83.9%) participants reported taking a polypharmacy regimen, and 68.2% reported use of at least one cytochrome P450 enzyme inhibitor or inducer during the trial. Our findings underscore the high prevalence of actionable PGx genotypes, polypharmacy, and use of inhibitors and inducers in older adults, which collectively have the potential to inform safer and more effective prescribing practices.
Details
- Title: Subtitle
- Prevalence of Actionable Pharmacogenetic Genotype Frequencies, Cautionary Medication Use, and Polypharmacy in Community-Dwelling Older Adults
- Creators
- Chad A Bousman - University of CalgaryAnkita Narang - University of CalgaryZiad Al Bkhetan - The University of MelbourneRobyn L Woods - Monash UniversitySuzanne G Orchard - Monash UniversityAlice J Owen - Monash UniversityMichelle A Fravel - University of IowaJulia Gilmartin-Thomas - Alfred HealthJoanne Ryan - Monash UniversityPeter D Fransquet - Monash UniversityRory Wolfe - Monash UniversityChenglong Yu - Monash UniversityJohn J McNeil - Monash UniversityPaul Lacaze - Monash UniversityMichael E Ernst - Department of Family and Community Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Clinical pharmacology and therapeutics, Vol.118(2), pp.337-342
- DOI
- 10.1002/cpt.3702
- PMID
- 40304392
- PMCID
- PMC12272320
- NLM abbreviation
- Clin Pharmacol Ther
- ISSN
- 1532-6535
- eISSN
- 1532-6535
- Publisher
- WILEY
- Grant note
- U01AG029824 / National Institute on Aging and the National Cancer Institute at the National Institutes of Health 334047 / National Health and Medical Research Council of Australia Monash University and the Victorian Cancer Agency IG 1173690 / NHMRC 2026325 / NHMRC U19AG062682 / National Institute on Aging and the National Cancer Institute at the National Institutes of Health 5U01AG029824-02 / NCI NIH HHS Commonwealth Scientific and Industrial Research Organization 1127060 / National Health and Medical Research Council of Australia
- Language
- English
- Electronic publication date
- 04/30/2025
- Date published
- 08/2025
- Academic Unit
- Family and Community Medicine; Pharmacy Practice and Science
- Record Identifier
- 9984816011502771
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