Martin Antony, Downing Jennifer, Maden Michelle, Fleeman Nigel, Alfirevic Ana, Haycox Alan, Pirmohamed Munir
NIHR CLAHRC NWC Wolfson Centre for Personalised Medicine, University of Liverpool, Block A: Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
Liverpool Reviews & Implementation Group, Universityof Liverpool, Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB, UK.
Pharmacogenomics. 2017 Nov;18(16):1541-1550. doi: 10.2217/pgs-2017-0076. Epub 2017 Nov 2.
This review assessed evidence of disparities in benefits of pharmacogenomics related to 'model performance' in subgroups of patients and studies which reported impact on health inequalities. 'Model performance' refers to the ability of algorithms including clinical, environmental and genetic information to guide treatment. A total of 4978 abstracts were screened by one reviewer and 30% (1494) were double screened by a second independent reviewer, after which data extraction was performed. Additional forward and backward citation searching of reference lists was conducted. Investigators independently double rated study quality and applicability of included studies. Only five individual studies were identified which met our inclusion criteria, but were contradictory in their conclusions. While three studies of genotype-guided dosing of warfarin reported that ethnic disparities in healthcare may widen, two other studies (one reporting on warfarin and reporting on clopidogrel) suggested that disparities in healthcare may reduce. There is a paucity of studies which evaluates the impact of pharmacogenomics on health disparities. Further work is required not only to evaluate health disparities between ethnic groups and countries but also within ethnic groups in the same country and solutions need to be identified to overcome these disparities.
本综述评估了在患者亚组和报告对健康不平等有影响的研究中，与“模型性能”相关的药物基因组学益处方面的差异证据。“模型性能”指的是包括临床、环境和遗传信息在内的算法指导治疗的能力。一位评审员筛选了总共4978篇摘要，30%（1494篇）由另一位独立评审员进行二次筛选，之后进行数据提取。还对参考文献列表进行了额外的向前和向后引文检索。研究人员独立对纳入研究的质量和适用性进行了双重评分。仅确定了五项符合我们纳入标准的个体研究，但它们的结论相互矛盾。虽然三项关于华法林基因型指导给药的研究报告称医疗保健中的种族差异可能会扩大，但另外两项研究（一项关于华法林，一项关于氯吡格雷）表明医疗保健差异可能会缩小。评估药物基因组学对健康差异影响的研究很少。不仅需要进一步开展工作来评估不同种族群体和国家之间的健康差异，还需要评估同一国家内种族群体内部的健康差异，并且需要确定克服这些差异的解决方案。
