Pharmacogenomics offers one of the best use cases for widespread clinical implementation of genomic medicine, as variants tend to have moderate allele frequencies, many of the affected medications are relatively common, and the magnitude of effect tends to be clinically meaningful. Using pharmacogenomic-guided warfarin dosing as an example, this dissertation addresses potential barriers and solutions to the clinical implementation of pharmacogenomics. Warfarin is a blood thinner that has a narrow therapeutic index and wide dosing variation, with many known pharmacogenomic markers associated with stable warfarin dose. A number of different methods to reduce disparities in pharmacogenomic-guided warfarin dosing among African Americans were tested. Additionally data from Vanderbiltâs clinical implementation of pharmacogenomic-guided warfarin dosing were analyzed to assess process outcomes (e.g. how did the actual warfarin dose ordered compare to the recommended dose) and patient outcomes (e.g., what kinds of clinical events did the patient experience immediately following warfarin initiation). A summary of policy and technological challenges for clinical implementation of precision medicine, along with potential solutions, are presented.
| Identifer | oai:union.ndltd.org:VANDERBILT/oai:VANDERBILTETD:etd-03282016-113802 |
| Date | 28 March 2016 |
| Creators | Wiley, Laura Katherine |
| Contributors | Joshua C. Denny, Melinda Aldrich, David Samuels, Dan Roden, Josh Peterson |
| Publisher | VANDERBILT |
| Source Sets | Vanderbilt University Theses |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.vanderbilt.edu/available/etd-03282016-113802/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to Vanderbilt University or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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