Projected utility of pharmacogenomic testing among individuals hospitalized with COVID-19: A retrospective multicenter study in the United States.

Many academic institutions are collecting blood samples from patients seeking treatment for COVID-19 to build research biorepositories. It may be feasible to extract pharmacogenomic information from biorepositories for clinical use. We sought to characterize the potential value of multi-gene pharmacogenomic testing among individuals hospitalized with COVID-19 in the United States. We performed a cross-sectional analysis of electronic health records from consecutive individuals hospitalized with COVID-19 at a large, urban academic health system. We characterized medication orders, focusing on medications with actionable pharmacogenomic guidance related to 14 commonly-assayed genes (CYP2C19, CYP2C9, CYP2D6, CYP3A5, DPYD, G6PD, HLA-A, HLA-B, IFNL3, NUDT15, SLCO1B1, TPMT, UGT1A1, VKORC1). A simulation analysis combined medication data with population phenotype frequencies to estimate how many treatment modifications would be enabled if multi-gene pharmacogenomic results were available. Sixty-four unique medications with pharmacogenomic guidance were ordered at least once in the cohort (n=1852, mean age 60.1 years). Nearly nine in ten individuals (89.7%) had at least one order for a medication with pharmacogenomic guidance and 427 patients (23.1%) had orders for 4 or more actionable medications. Using a simulation, we estimated that 17 treatment modifications per 100 patients would be enabled if pharmacogenomic results were available. The genes CYP2D6 and CYP2C19 were responsible for the majority of treatment modifications, and the medications most often affected were ondansetron, oxycodone, and clopidogrel. Pharmacogenomic results would be relevant for nearly all individuals hospitalized with COVID-19 and would provide the opportunity to improve clinical care.