Influence of metabolic profiles on the safety of drug therapy in routine care in Germany: protocol of the cohort study EMPAR

• Published in: BMJ open Vol. 10; no. 4; p. e032624
• Main Authors: Huebner, Tatjana, Steffens, Michael, Linder, Roland, Fracowiak, Jochen, Langner, Daria, Garling, Marco, Falkenberg, Felix, Roethlein, Christoph, Gomm, Willy, Haenisch, Britta, Stingl, Julia
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 27.04.2020; BMJ Publishing Group
• Series: Protocol
• Subjects: Adult; Anticoagulants; Anticoagulants - adverse effects; Cohort analysis; Cohort Studies; Drug dosages; Drug therapy; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - genetics; Drug-Related Side Effects and Adverse Reactions - metabolism; Drug-Related Side Effects and Adverse Reactions - prevention & control; Germany - epidemiology; Health insurance; Health Services Needs and Demand - economics; Health Services Needs and Demand - statistics & numerical data; Health Services Research; Humans; Hypolipidemic Agents - adverse effects; Insurance, Health - statistics & numerical data; Machine Learning; Metabolome; Pharmacoepidemiology; Polymorphism, Single Nucleotide; Precision medicine; Germany; precision medicine; health care research; pharmacogenetics; health economics; pharmacoepidemiology
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-032624

IntroductionPre-emptive testing of pharmacogenetically relevant single-nucleotide polymorphisms can be an effective tool in the prevention of adverse drug reactions and therapy resistance. However, most of the tests are not used as standard in routine care in Germany because of lacking evidence for the clinical and economical benefit and their impact on the usage of healthcare services. We address this issue by investigating the influence of pharmacogenetic profiles on the use of healthcare services over an extended period of several years using routine care data from a statutory health insurance company. The goal is to provide clinical evidence whether pre-emptive pharmacogenetic testing of metabolic profiles in routine care in Germany is beneficial and cost-effective.Methods and analysisThe EMPAR (Einfluss metabolischer Profile auf die Arzneimitteltherapiesicherheit in der Routineversorgung) study is a non-interventional cohort study conducted to analyse pharmacogenetic risk factors that are important for drug therapy by means of endpoints relevant for healthcare. The analysis is based on pharmacogenetic profiles and statutory health insurance data. We perform pharmacogenetic, pharmacoepidemiological and pharmacoeconomic analyses using health care utilisation scores and machine learning techniques. Therefore, we aim to include about 10 000 patients (≥18 years) insured by the health insurance provider Techniker Krankenkasse. The study focuses on patients with prescriptions of anticoagulants and prescriptions of cholesterol-lowering drugs. Also, a screening for special pharmacogenetic characteristics will be performed in patients with at least one Y57.9! diagnosis (Complication of medical and surgical care: drug or medicament, unspecified). Outcomes include the utilisation of health insurance services, the incidence of incapacity for work and costs for drugs and treatment.Ethics and disseminationThe protocol was approved by the Ethics Committee of the Medical Faculty, University of Bonn (Lfd. Nr. 339/17). The results of this research project will be published in scientific open access journals and at conferences.Trial registration numberGerman Clinical Trials Register, DRKS00013909.