Klein Michelle E, Parvez Md Masud, Shin Jae-Gook
Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea.
Department of Pharmacology and PharmacoGenomics Research Center, Inje University College of Medicine, Busan, Republic of Korea; Department of Clinical Pharmacology, Inje University Busan Paik Hospital, Busan, Republic of Korea.
J Pharm Sci. 2017 Sep;106(9):2368-2379. doi: 10.1016/j.xphs.2017.04.051. Epub 2017 Jun 13.
Clinical implementation of pharmacogenomics (PGx) leads to personalized medicine, which improves the efficacy, safety, and cost-effectiveness of treatments. Although PGx-based research has been conducted for more than a decade, several barriers have slowed down its widespread implementation in clinical practice. Globally, there is an imbalance in programs and solutions required to empower the clinical implementation of PGx between countries. Therefore, we aimed to review these issues comprehensively, determine the major barriers, and find the best solutions. Through an extensive review of ongoing clinical implementation programs, scientific, educational, ethical, legal, and social issues, information technology, and reimbursement were identified as the key barriers. The pace of global implementation of genomic medicine coincided with the resource limitations of each country. The key solutions identified for the earlier mentioned barriers are as follows: building of secure and suitable information technology infrastructure with integrated clinical decision support systems along with increasing PGx evidence, more regulations, reimbursement strategies for stakeholder's acceptance, incorporation of PGx education in all institutions and clinics, and PGx promotion to all health care professionals and patients. In conclusion, this review will be helpful for the better understanding of common barriers and solutions pertaining to the clinical application of PGx.
药物基因组学(PGx)的临床应用可实现个性化医疗,从而提高治疗的有效性、安全性和成本效益。尽管基于PGx的研究已开展了十多年,但仍有一些障碍减缓了其在临床实践中的广泛应用。在全球范围内,各国在推动PGx临床应用所需的项目和解决方案方面存在不平衡。因此,我们旨在全面审视这些问题,确定主要障碍,并找到最佳解决方案。通过对正在进行的临床应用项目进行广泛审查,发现科学、教育、伦理、法律和社会问题、信息技术以及报销是关键障碍。基因组医学在全球的应用速度与各国的资源限制相吻合。针对上述障碍确定的关键解决方案如下:建立具有集成临床决策支持系统的安全合适的信息技术基础设施,同时增加PGx证据、更多法规、有利于利益相关者接受的报销策略、在所有机构和诊所纳入PGx教育,以及向所有医护人员和患者推广PGx。总之,本综述将有助于更好地理解与PGx临床应用相关的常见障碍和解决方案。