ArticlePharmacogenetics and genomics2015
Poor warfarin dose prediction with pharmacogenetic algorithms that exclude genotypes important for African Americans.
Article in Pharmacogenetics and genomics, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 3 of them syntheses that pooled it.
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Who cites it
47 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Recommendations for Clinical Warfarin Genotyping Allele Selection: A Report of the Association for Molecular Pathology and the College of American Pathologists.The Journal of molecular diagnostics : JMD · 2020Guideline
- Genetic Factors Influencing Warfarin Dose in Black-African Patients: A Systematic Review and Meta-Analysis.Clinical pharmacology and therapeutics · 2020Pooled it
- Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Pharmacogenetics-Guided Warfarin Dosing: 2017 Update.Clinical pharmacology and therapeutics · 2017Guideline
- Bridging Ancestry-Stratified Bias in Pharmacogenomics AI: Toward Metabolomics-Inclusive Multi-Omics Precision Medicine.Journal of personalized medicine · 2026Review
- A Framework to Quantify Disparities in Pharmacogenomic Treatment Concordance and Drug Response Outcomes.Clinical and translational science · 2026Article
- Comparison of CYP2C9 activity between Ethiopian and non-Ethiopian Jews: an interethnic study of (Frontiers in pharmacology · 2026Article
- A Framework to Quantify Disparities in Pharmacogenomic Treatment Concordance and Drug Response Outcomes.medRxiv : the preprint server for health sciences · 2025Article
- Review
- The Intersection between Pharmacogenomics and Health Equity: A Case Example.Pharmacy (Basel, Switzerland) · 2023Review
- An Introductory Tutorial on Cardiovascular Pharmacogenetics for Healthcare Providers.Clinical pharmacology and therapeutics · 2023Article
- The frequency of majorPharmacogenomics · 2023Article
- Cardiovascular precision medicine - A pharmacogenomic perspective.Cambridge prisms. Precision medicine · 2023Review
- Building Evidence for Clinical Use of Pharmacogenomics and Reimbursement for Testing.Clinics in laboratory medicine · 2022Review
- How to Implement a Pharmacogenetics Service at your Institution.Journal of the American College of Clinical Pharmacy : JACCP · 2022Article
- Warfarin Dosing in Patients With CYP2C9*5 Variant Alleles.Clinical pharmacology and therapeutics · 2022Article
- Polygenic risk scores: An overview from bench to bedside for personalised medicine.Frontiers in genetics · 2022Review
- PharmVar GeneFocus: CYP2C9.Clinical pharmacology and therapeutics · 2021Review
- Pharmacogenetics to guide cardiovascular drug therapy.Nature reviews. Cardiology · 2021Review
- Machine Learning for Prediction of Stable Warfarin Dose in US Latinos and Latin Americans.Frontiers in pharmacology · 2021Article
- Heterologous Expression and Functional Characterization of Novel CYP2C9 Variants Identified in the Alaska Native People.The Journal of pharmacology and experimental therapeutics · 2020Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectivesRecent clinical trial data cast doubt on the utility of genotype-guided warfarin dosing, specifically showing worse dosing with a pharmacogenetic versus clinical dosing algorithm in African Americans. However, many genotypes important in African Americans were not accounted for. We aimed to determine whether omission of the CYP2C9*5, CYP2C9*6, CYP2C9*8, CYP2C9*11 alleles and rs12777823 G > A genotype affects performance of dosing algorithms in African Americans.
methodsIn a cohort of 274 warfarin-treated African Americans, we examined the association between the CYP2C9*5, CYP2C9*6, CYP2C9*8, CYP2C9*11 alleles and rs12777823 G > A genotype and warfarin dose prediction error with pharmacogenetic algorithms used in clinical trials.
resultsThe http://www.warfarindosing.org algorithm overestimated doses by a median (interquartile range) of 1.2 (0.02-2.6) mg/day in rs12777823 heterozygotes (P<0.001 for predicted vs. observed dose), 2.0 (0.6-2.8) mg/day in rs12777823 variant homozygotes (P = 0.004), and 2.2 (0.5-2.9) mg/day in carriers of a CYP2C9 variant (P < 0.001). The International Warfarin Pharmacogenetics Consortium (IWPC) algorithm underdosed warfarin by 0.8 (-2.3 to 0.4) mg/day for patients with the rs12777823 GG genotype (P < 0.001) and overdosed warfarin by 0.7 (-0.4 to 1.9) mg/day in carriers of a variant CYP2C9 allele (P = 0.04). Modifying the http://www.warfarindosing.org algorithm to adjust for variants important in African Americans led to better dose prediction than either the original http://www.warfarindosing.org (P < 0.01) or IWPC (P < 0.01) algorithm.
conclusionThese data suggest that, when providing genotype-guided warfarin dosing, failure to account for variants important in African Americans leads to significant dosing error in this population.
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