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Cytochrome P450 interactions are common and consequential in Massachusetts hospital discharges

The Pharmacogenomics Journal volume 18, pages 347–350 (2018)Cite this article

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Abstract

Despite the recognition that drug–drug interactions contribute substantially to preventable health-care costs, the prevalence of such interactions related to the cytochrome P450 system in clinical practice remains poorly characterized. This study drew retrospective hospital discharge cohorts from a large health claims data set and a large health system data set. For every hospital discharge, frequency of co-occurrence of substrates and inducers or inhibitors at cytochrome P450 2D6, 2C19, 3A4 and 1A2 were determined. A total of 124 520 individuals in the state of Massachusetts (health claims cohort) and 77 026 individuals in two large academic medical centers (electronic health record (EHR) cohort) were examined. In the claims cohort, 35 157 (28.2%) exhibited at least one CYP450 drug–drug interaction at hospital discharge, whereas in the EHR cohort, 36 750 (47.7%) had at least one interaction. The most commonly affected CYP450 systems were 2C19 and 2D6, with putative interactions observed in at least 10% of individuals at discharge in each cohort. Odds of hospital readmission within 90 days among those discharged with at least one interaction were 10–16% greater, with mean health-care cost $574/month greater over the subsequent year, after adjusting for age, sex, insurance type, total number of medications prescribed, Charlson comorbidity score and presence or absence of a psychiatric diagnosis. These two distinct clinical data types show that CYP450 drug–drug interactions are prevalent and associated with greater probability of early hospital readmission and greater health-care cost, despite the widespread availability and application of drug–drug interaction checking software.

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Authors and Affiliations

  1. Department of Psychiatry, Center for Experimental Drugs and Diagnostics, Massachusetts General Hospital, Boston, MA, USA

    T H McCoy, V M Castro, A Cagan, L Snapper, A Roberson & R H Perlis

  2. Partners Research Computing, Partners HealthCare System, One Constitution Center, Boston, MA, USA

    V M Castro & A Cagan

  3. Laboratory of Computer Science and Department of Neurology, Massachusetts General Hospital, Boston, MA, USA

    V M Castro & A Cagan

Authors
  1. T H McCoy
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  2. V M Castro
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  3. A Cagan
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  4. L Snapper
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  5. A Roberson
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  6. R H Perlis
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Corresponding author

Correspondence to R H Perlis.

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Competing interests

All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author). RHP has served on advisory boards or provided consulting to Genomind, Healthrageous, Perfect Health, Pfizer, Psybrain and RIDVentures. VMC, AR, AC, THM and LS declare no conflict of interest.

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Author contributions

VMC and AC cleaned and formatted the data set, generated variables for analysis and contributed to the interpretation of results and manuscript preparation. AR and LS contributed to preparation of the manuscript. THM developed algorithms for parsing medication lists based on cytochrome P450 status, contributed to study design and helped to draft the manuscript. RHP initiated the project, designed the study, conducted the analyses and helped to draft the manuscript. He is a guarantor. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. RHP affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study have been explained.

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McCoy, T., Castro, V., Cagan, A. et al. Cytochrome P450 interactions are common and consequential in Massachusetts hospital discharges. Pharmacogenomics J 18, 347–350 (2018). https://doi.org/10.1038/tpj.2017.30

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