VIP-Hmong

Table 1. Total Group Results for VIP-Hmong Study

Information about the Medicines Tshuaj******		Percent of people who may need a… Pes tsawg feem puas tus neeg teb zaum yuav tsum siv..
Medicine is used for.. Tshuaj siv kho mob dabtsis	Medicines (generic/brand) Tshuaj Npe	LOWER dose Tsawg dua	USUAL dose Nruab nrab	HIGHER dose Ntau dua	DIFFERENT drug Lwm yam tshuaj
Blood Clots	Clopidogrel Plavix		34%		66%
Blood Clots	Warfarin Cancer	82%	2%		16%
Cancer	Azathioprine *Imuran*	1%	99%
Cancer	Capecitabine *Xeloda*		100%
Cancer	Fluorouracil *5-FU*		100%
Cancer	Mercaptopurine *Purixan*	1%	99%
Cancer	Tegafur *INN, BAN, USAN*		100%
Cancer	Thioguanine *Tabloid*	1%	99%
Depression	Citalopram Celexa	20%	80%		20%
Depression	Escitalopram Lexapro	20%	80%		20%
Depression	Sertraline Zoloft	20%	80%		20%
Gout	Rasburicase *Elitek*		100%
High Cholesterol	Simvastatin *Zocor*	6%	94%		6%
Infection: Fungi	Voriconazole *Vfend*	20%	80%		20%
Neuropathic Pain	Amitriptyline *Elavil*	20%	80%		20%
Neuropathic Pain	Clomipramine *Anafranil*	20%	80%		20%
Neuropathic Pain	Doxepin *Prudoxin, Silenor, Zonalon*	20%	80%		20%
Neuropathic Pain	Imipramine *Tofranil*	20%	80%		20%
Neuropathic Pain	Trimipramine *Surmontil*	20%	80%		20%
Seizures	Phenytoin *Dilantin*	22%	78%
Ulcerative Colitis	Mercaptopurine *Purixan*	1%	99%
Ulcerative Colitis	Thioguanine *Tabloid*	1%	99%

Reference

PGx Gene-specific Information Tables for CYP2C19. < https://www.pharmgkb.org/page/cyp2c19RefMaterials>. Accessed March 13, 2018.
PGx Gene-specific Information Tables for CYP2C9. < https://www.pharmgkb.org/page/cyp2c9RefMaterials>. Accessed March 13, 2018.
PGx Gene-specific Information Tables for VKORC1. < https://www.pharmgkb.org/page/vkorc1RefMaterials>. Accessed March 13, 2018.
PGx Gene-specific Information Tables for CYP4F2. < https://www.pharmgkb.org/page/cyp4f2RefMaterials>. Accessed March 13, 2018.
Johnson JA, Caudle KE, Gong L, Whirl-Carrillo M, Stein CM, Scott SA, Lee MT, Gage BF, Kimmel SE, Perera MA, Anderson JL, Pirmohamed M, Klein TE, Limdi NA, Cavallari LH, Wadelius M. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Pharmacogenetics-Guided Warfarin Dosing: 2017 Update. Clin Pharmacol Ther. 2017 Sep;102(3):397-404. doi: 10.1002/cpt.668. Epub 2017 Apr
PGx Gene-specific Information Tables for TPMT. < https://www.pharmgkb.org/page/tpmtRefMaterials>. Accessed March 13, 2018.
Relling MV, Gardner EE, Sandborn WJ, Schmiegelow K, Pui CH, Yee SW, Stein CM, Carrillo M, Evans WE, Klein TE; Clinical Pharmacogenetics Implementation Consortium. Clinical Pharmacogenetics Implementation Consortium guidelines for thiopurine methyltransferase genotype and thiopurine dosing. Clin Pharmacol Ther. 2011 Mar;89(3):387-91. doi: 10.1038/clpt.2010.320. Epub 2011 Jan 26.
PGx Gene-specific Information Tables for DPYD. < https://www.pharmgkb.org/page/dpydRefMaterials>. Accessed March 13, 2018.
PGx Gene-specific Information Tables for G6PD. < https://www.pharmgkb.org/page/g6pdRefMaterials>. Accessed March 13, 2018.
PGx Gene-specific Information Tables for SLCO1B1. < https://www.pharmgkb.org/page/slco1b1RefMaterials>. Accessed March 13, 2018.

Very Important Pharmacogenes in Hmong (VIP-Hmong) study was conducted to understand how Hmong people’s genes (or DNA) might affect how medicines work.

199 Hmong people joined the study. Everyone spit into a tube so we could find DNA in cheek cells.
We looked for everyone’s genes but could not see enough DNA from 17 people’s cells, so we could not use their samples.

Analysis: For the 182 Hmong people, we looked at 22 variations in select genes important for 20 unique medicines. Then, from other studies and guidelines, we looked to see if the genetic variations would change the recommended starting dose of each medicine.

If people do not have genetic variations, they can take the usual drug dose.
If people do have specific genetic variations, they may need take a lower dose, take a higher dose, or take an alternative medicine.

Table 2 Comparison between Hmong and White

Medicine is used for.. Tshuaj siv kho mob dabtsis	Medicines (generic/brand) Tshuaj Npe	Ethnicity Group	LOWER dose Tsawg dua	USUAL dose Nruab nrab	HIGHER dose Ntau dua	DIFFERENT drug Lwm yam tshuaj
Blood Clots	Clopidogrel Plavix	Hmong		34%		66%
Blood Clots	Clopidogrel Plavix	White¹		71%		29%
Blood Clots	Warfarin *Coumadin*	Hmong	82%	2%		16%
Blood Clots	Warfarin *Coumadin*	White^2-5	70%	17%	11%	2%
Cancer	Azathioprine *Imuran*	Hmong	1%	99%
Cancer	Azathioprine *Imuran*	White^6,7	8.3%	92%		0.3%
Cancer	Capecitabine *Xeloda*	Hmong		100%
Cancer	Capecitabine *Xeloda*	White⁸	4%	96%		0.2%
Cancer	Fluorouracil *5-FU*	Hmong		100%
Cancer	Fluorouracil *5-FU*	White⁸	4%	96%		0.2%
Cancer	Mercaptopurine *Purixan*	Hmong	1%	99%
Cancer	Mercaptopurine *Purixan*	White^6,7	8.3%	92%
Cancer	Tegafur *INN, BAN, USAN*	Hmong		100%
Cancer	Tegafur *INN, BAN, USAN*	White⁸	4%	96%		0.2%
Cancer	Thioguanine *Tabloid*	Hmong	1%	99%
Cancer	Thioguanine *Tabloid*	White^6,7	8.3%	92%
Depression	Citalopram Celexa	Hmong	20%	80%		20%
Depression	Citalopram Celexa	White¹	3%	66%		34%
Depression	Escitalopram Lexapro	Hmong	20%	80%		20%
Depression	Escitalopram Lexapro	White¹	3%	66%		34%
Depression	Sertraline Zoloft	Hmong	20%	80%		20%
Depression	Sertraline Zoloft	White¹	3%	66%		34%
Gout	Rasburicase *Elitek*	Hmong		100%
Gout	Rasburicase *Elitek*	White⁹		96%		4%
High Cholesterol	Simvastatin *Zocor*	Hmong	6%	94%		6%
High Cholesterol	Simvastatin *Zocor*	White¹⁰	48%	52%		48%
Infection: Fungi	Voriconazole *Vfend*	Hmong	20%	80%		20%
Infection: Fungi	Voriconazole *Vfend*	White¹	3%	66%		34%
Neuropathic Pain	Amitriptyline *Elavil*	Hmong	20%	80%		20%
Neuropathic Pain	Amitriptyline *Elavil*	White¹	3%	98%		34%
Neuropathic Pain	Clomipramine *Anafranil*	Hmong	20%	80%		20%
Neuropathic Pain	Clomipramine *Anafranil*	White¹	3%	98%		34%
Neuropathic Pain	Doxepin *Prudoxin, Silenor, Zonalon*	Hmong	20%	80%		20%
Neuropathic Pain	Doxepin *Prudoxin, Silenor, Zonalon*	White¹	3%	98%		34%
Neuropathic Pain	Imipramine *Tofranil*	Hmong	20%	80%		20%
Neuropathic Pain	Imipramine *Tofranil*	White¹	3%	98%		34%
Neuropathic Pain	Trimipramine *Surmontil*	Hmong	20%	80%		20%
Neuropathic Pain	Trimipramine *Surmontil*	White¹	3%	98%		34%
Seizures	Phenytoin *Dilantin*	Hmong	22%	78%
Seizures	Phenytoin *Dilantin*	White¹	36%	64%
Ulcerative Colitis	Mercaptopurine *Purixan*	Hmong	1%	99%
Ulcerative Colitis	Mercaptopurine *Purixan*	White^6,7	8%	92%		0.3%
Ulcerative Colitis	Thioguanine *Tabloid*	Hmong	1%	99%
Ulcerative Colitis	Thioguanine *Tabloid*	White^6,7	8%	92%		0.3%

Table 3 Comparison between Hmong and East Asian

Medicine is used for.. Tshuaj siv kho mob dabtsis	Medicines (generic/brand) Tshuaj Npe	Ethnicity Group	LOWER dose Tsawg dua	USUAL dose Nruab nrab	HIGHER dose Ntau dua	DIFFERENT drug Lwm yam tshuaj
Blood Clots	Clopidogrel Plavix	*Hmong*		34%		66%
Blood Clots	Clopidogrel Plavix	*Asian¹*		38%		62%
Blood Clots	Warfarin *Coumadin*	*Hmong*	82%	2%		16%
Blood Clots	Warfarin *Coumadin*	*Asian^2-5*	98.8%	0.6%	0.5%	0.07%
Cancer	Azathioprine *Imuran*	*Hmong*	1%	99%
Cancer	Azathioprine *Imuran*	*Asian^6,7*	3%	97%		0.02%
Cancer	Capecitabine *Xeloda*	*Hmong*		100%
Cancer	Capecitabine *Xeloda*	*Asian⁸*	0.3%	99.7%		0.0002%
Cancer	Fluorouracil *5-FU*	*Hmong*		100%
Cancer	Fluorouracil *5-FU*	*Asian⁸*	0.3%	99.7%		0.0002%
Cancer	Mercaptopurine *Purixan*	*Hmong*	1%	99%
Cancer	Mercaptopurine *Purixan*	*Asian^6,7*	3%	97%
Cancer	Tegafur *INN, BAN, USAN*	*Hmong*		100%
Cancer	Tegafur *INN, BAN, USAN*	*Asian⁸*	0.3%	99.7%		0.0002%
Cancer	Thioguanine *Tabloid*	*Hmong*	1%	99%
Cancer	Thioguanine *Tabloid*	*Asian^6,7*	3%	97%
Depression	Citalopram Celexa	*Hmong*	20%	80%		20%
Depression	Citalopram Celexa	*Asian¹*	15%	84%		16%
Depression	Escitalopram Lexapro	*Hmong*	20%	80%		20%
Depression	Escitalopram Lexapro	*Asian¹*	15%	84%		16%
Depression	Sertraline Zoloft	*Hmong*	20%	80%		20%
Depression	Sertraline Zoloft	*Asian¹*	15%	84%		16%
Gout	Rasburicase *Elitek*	*Hmong*		100%
Gout	Rasburicase *Elitek*	*Asian⁹*		95%		5%
High Cholesterol	Simvastatin *Zocor*	*Hmong*	6%	94%		6%
High Cholesterol	Simvastatin *Zocor*	*Asian¹⁰*	26%	74%		26%
Infection: Fungi	Voriconazole *Vfend*	*Hmong*	20%	80%		20%
Infection: Fungi	Voriconazole *Vfend*	*Asian¹*	15%	84%		16%
Neuropathic Pain	Amitriptyline *Elavil*	*Hmong*	20%	80%		20%
Neuropathic Pain	Amitriptyline *Elavil*	*Asian¹*	15%	85%		16%
Neuropathic Pain	Clomipramine *Anafranil*	*Hmong*	20%	80%		20%
Neuropathic Pain	Clomipramine *Anafranil*	*Asian¹*	15%	85%		16%
Neuropathic Pain	Doxepin *Prudoxin, Silenor, Zonalon*	*Hmong*	20%	80%		20%
Neuropathic Pain	Doxepin *Prudoxin, Silenor, Zonalon*	*Asian¹*	15%	85%		16%
Neuropathic Pain	Imipramine *Tofranil*	*Hmong*	20%	80%		20%
Neuropathic Pain	Imipramine *Tofranil*	*Asian¹*	15%	85%		16%
Neuropathic Pain	Trimipramine *Surmontil*	*Hmong*	20%	80%		20%
Neuropathic Pain	Trimipramine *Surmontil*	*Asian¹*	15%	85%		16%
Seizures	Phenytoin *Dilantin*	*Hmong*	22%	78%
Seizures	Phenytoin *Dilantin*	*Asian¹*	7%	93%
Ulcerative Colitis	Mercaptopurine *Purixan*	*Hmong*	1%	99%
Ulcerative Colitis	Mercaptopurine *Purixan*	*Asian^6,7*	3%	97%		0.02%
Ulcerative Colitis	Thioguanine *Tabloid*	*Hmong*	1%	99%
Ulcerative Colitis	Thioguanine *Tabloid*	*Asian^6,7*	3%	97%		0.02%

List of Genetic Variations Tested in VIP-Hmong Study

We tested the following genetic variations or single nucleotide polymorphisms (SNPs).
We used guidelines from Clinical Pharmacogenetics Implementation Consortium (CPIC) to decide on the medication recommendations.

CYP2C9	2, 3
rs1057910
rs1799853
CYP2C19	2, 3, 4, 5, 6, 8,*17
rs12248560
rs28399504
rs4244285
rs4986893
rs56337013
rs72552267
rs41291556
CYP4F2	*3
rs2108622
DPYD	2A (1905+1G>A, IVS14+1G>A), ASP949VAL, 13
rs3918290
rs55886062
rs67376798
G6PD
rs1050828
rs5030868
rs72554665
SLCO1B1	*5
rs4149056
TPMT	2, 3A, 3B, 3C, *4
rs1142345
rs1800460
rs1800462
rs1800584
VKORC1	PROMOTER VARIANT -1639G>A
rs9923231

Table 1. Total Group Results for VIP-Hmong Study

34%

66%

82%

2%

16%

1%

99%

100%

100%

1%

99%

100%

1%

99%

20%

80%

20%

20%

80%

20%

20%

80%

20%

100%

6%

94%

6%

20%

80%

20%

20%

80%

20%

20%

80%

20%

20%

80%

20%

20%

80%

20%

20%

80%

20%

22%

78%

1%

99%

1%

99%

Reference

Table 2 Comparison between Hmong and White

34%

66%

82%

2%

16%

1%

99%

100%

100%

1%

99%

100%

1%

99%

20%

80%

20%

20%

80%

20%

20%

80%

20%

100%

6%