Our initial studies in this area demonstrated that reported genomic predictors of common drug outcomes could be readily replicated in BioVU. These included CYP2C19*2 and major adverse cardiovascular events (MACE) in patients receiving clopidogrel after coronary stenting,23 CYP2C9 and VKORC1 variants and steady state warfarin dosages,24 and CYP3A5*3 and tacrolimus concentrations after renal transplant.25 The Pharmacogenomics Research Network (PGRN) supported the development of the PGPop (PharmacoGenomic discovery and replication in very large patient POPulations) resource for mining EHR systems for pharmacogenomic response phenotypes (Table 1). PGPop used BioVU, the Marshfield Personalized Medicine Research Project (PMRP), and other datasets for discovery of new genotype-phenotype associations by PGRN investigators. Other drug-response genotypes addressed using EHR resources have included thromboembolism during tamoxifen,26 cough during ACE inhibitor therapy,27 heparin-induced thrombocytopenia,28 creatinine concentrations during vancomycin therapy,29 osteonecrosis during steroid therapy,30 and anthracycline-related changes in ejection fraction.31
