Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA.
Can J Cardiol. 2013 Jan;29(1):58-66. doi: 10.1016/j.cjca.2012.07.845. Epub 2012 Nov 27.
Responses to drug therapy vary from benefit to no effect to adverse effects which can be serious or occasionally fatal. Increasing evidence supports the idea that genetic variants can play a major role in this spectrum of responses. Well-studied examples in cardiovascular therapeutics include predictors of steady-state warfarin dosage, predictors of reduced efficacy among patients receiving clopidogrel for drug eluting stents, and predictors of some serious adverse drug effects. This review summarizes contemporary approaches to identifying and validating genetic predictors of variability in response to drug treatment. Approaches to incorporating this new knowledge into clinical care, and the barriers to this concept, are addressed.
药物治疗的反应各不相同，从受益到无效，再到严重甚至偶尔致命的不良反应。越来越多的证据支持这样一种观点，即遗传变异可以在这种反应谱中发挥重要作用。心血管治疗中研究充分的例子包括华法林稳定剂量的预测因子、接受氯吡格雷治疗药物洗脱支架的患者疗效降低的预测因子，以及一些严重药物不良反应的预测因子。这篇综述总结了目前用于识别和验证药物治疗反应变异性的遗传预测因子的方法。还讨论了将这一新知识纳入临床护理的方法以及这一概念的障碍。
