Managing differential performance of polygenic risk scores across groups: Real-world experience of the eMERGE Network.

The differential performance of polygenic risk scores (PRSs) by group is one of the major ethical barriers to their clinical use. It is also one of the main practical challenges for any implementation effort. The social repercussions of how people are grouped in PRS research must be considered in communications with research participants, including return of results. Here, we outline the decisions faced and choices made by a large multi-site clinical implementation study returning PRSs to diverse participants in handling this issue of differential performance. Our approach to managing the complexities associated with the differential performance of PRSs serves as a case study that can help future implementers of PRSs to plot an anticipatory course in response to this issue.
Competing Interests: Declaration of interests A.C.F.L. owns some stock in Fabric Genomics; E.D.E. is an employee and stockholder of Invitae, advisor and stockholder of Taproot Health, and advisor and stockholder of Exir; R.C.G. receives compensation for advising the following companies: Allelica, Atria, Fabric, Genomic Life, and Juniper Genomics; and is co-founder of Genome Medical and Nurture Genomics; E.E.K. has received personal fees from Regeneron Pharmaceuticals, 23&Me, Allelica, and Illumina; has received research funding from Allelica; and serves on the advisory boards for Encompass Biosciences, Overtone, and Galatea Bio; N.L. received personal fees from Illumina Inc; E.P. is a paid consultant for Allelica Inc.; M.S. is a member of the Institutional Review Board of the All of Us Research Program; J.W.S. is a member of the Scientific Advisory Board of Sensorium Therapeutics (with equity), has received grant support from Biogen, Inc., and is PI of a collaborative study of the genetics of depression and bipolar disorder sponsored by 23andMe for which 23andMe provides analysis time as in-kind support but no payments.
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