Kim Young Mi, Yoo Seung Hee, Kang Rae Young, Kim Min Jung, Bae Yoon Young, Lee Yeon Kyung, Jeon Su Jin, Chon Kung Ju, Shin Sang Mi, Kim Sang Geon, Park Kyoung Ho, Son In Ja
Department of Pharmacy, Seoul National University Hospital, Seoul, Korea.
Am J Health Syst Pharm. 2007 Jan 15;64(2):166-75. doi: 10.2146/ajhp050490.
A decision matrix for identifying drugs for which pharmacogenetic drug monitoring (PDM) provides the greatest benefit in a Korean setting is described.
We developed a decision matrix including the ethnic frequency of clinically relevant polymorphic cytochrome P-450 (CYP) enzymes, and the metabolic profiles and adverse drug reactions of drugs. Using the developed decision matrix based on the population allele frequencies of CYP enzymes, we identified potential candidates for PDM among the most commonly used drugs at Seoul National University Hospital (SNUH). Collectively, 17 of these drugs were largely metabolized by at least one polymorphic CYP enzyme. Pharmacogenetic information was used to identify CYP2C9, CYP2C19, and CYP2D6 as the major CYP enzymes of clinical importance for pharmacologic effect and safety in Koreans. The frequencies of poor and intermediate metabolizers among Koreans were 0% and 2.3-12% for CYP2C9, 12% and 42% for CYP2C19, and 0.44% and 28% for CYP2D6, respectively. The frequency of ultrarapid metabolizers of CYP2D6 was 2.28%. The decision matrix and pharmacogenetic information were used to identify seven drugs for PDM: warfarin, glimepiride, diazepam, amitriptyline, nortriptyline, codeine, and oxycodone. This approach can be applied to other institutional hospitals or other ethnic populations and would be helpful for advancing pharmacy practice. Further work is required to assess the practical and potential clinical relevance of pharmacogenetic variations on drugs of interest before the implementation of PDM.
A decision matrix helped identify drugs for which PDM provides the greatest potential benefit at one Korean hospital.
描述一种用于识别在韩国环境中药理基因药物监测（PDM）能带来最大益处的药物的决策矩阵。
我们开发了一种决策矩阵，其中包括临床相关多态性细胞色素P - 450（CYP）酶的种族频率以及药物的代谢谱和药物不良反应。利用基于CYP酶群体等位基因频率开发的决策矩阵，我们在首尔国立大学医院（SNUH）最常用的药物中确定了PDM的潜在候选药物。总体而言，这些药物中有17种主要由至少一种多态性CYP酶代谢。药物遗传学信息被用于确定CYP2C9、CYP2C19和CYP2D6是对韩国人药理作用和安全性具有临床重要性的主要CYP酶。韩国人中CYP2C9慢代谢者和中间代谢者的频率分别为0%和2.3 - 12%，CYP2C19分别为12%和42%，CYP2D6分别为0.44%和28%。CYP2D6超快代谢者的频率为2.28%。决策矩阵和药物遗传学信息被用于确定7种PDM药物：华法林、格列美脲、地西泮、阿米替林、去甲替林、可待因和羟考酮。这种方法可应用于其他机构医院或其他种族人群，有助于推进药学实践。在实施PDM之前，需要进一步开展工作来评估药物遗传学变异对相关药物的实际和潜在临床相关性。
一种决策矩阵有助于在一家韩国医院识别出PDM能带来最大潜在益处的药物。
