Veterans Affairs (VA) VA Boston Healthcare System, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Clin Pharmacol Ther. 2019 Aug;106(2):360-373. doi: 10.1002/cpt.1223. Epub 2018 Oct 18.
Demonstrated improvements in patient outcomes will facilitate the clinical implementation of pharmacogenetic testing. Using the association between solute carrier organic anion transporter family member 1B1 (SLCO1B1) and statin-associated muscle symptoms (SAMSs) as a model, we conducted a systematic review of patient outcomes after delivery of SLCO1B1 results. Using PubMed and Embase searches through December 19, 2017, we identified 37 eligible records reporting preliminary or final outcomes, including six studies delivering only SLCO1B1 results and five large healthcare system-based implementation projects of multipharmacogene panels. Two small trials have demonstrated at least short-term improvements in low-density lipoprotein cholesterol after SLCO1B1 testing among previously statin intolerant patients. Evidence from large implementation projects suggests that SLCO1B1 results may change prescribing patterns for some high-risk patients. No study has reported improvements in SAMSs or cardiovascular events or tracked the economic outcomes of SLCO1B1 testing. Ongoing studies should collect and report outcomes relevant to pharmacogenetics stakeholders.
患者结局的改善将有助于临床实施药物遗传学检测。我们以溶质载体有机阴离子转运家族成员 1B1（SLCO1B1）与他汀类药物相关肌肉症状（SAMSs）之间的关联为例，对 SLCO1B1 检测结果发布后患者结局进行了系统评价。通过 2017 年 12 月 19 日对 PubMed 和 Embase 的检索，我们确定了 37 项符合初步或最终结局的合格记录，其中包括 6 项仅报告 SLCO1B1 结果的研究和 5 项基于大型医疗保健系统的多基因药物组面板实施项目。两项小型试验表明，在先前他汀类药物不耐受的患者中，进行 SLCO1B1 检测后，低密度脂蛋白胆固醇至少在短期内有所改善。来自大型实施项目的证据表明，SLCO1B1 结果可能会改变某些高危患者的处方模式。没有研究报告 SAMSs 或心血管事件的改善，也没有跟踪 SLCO1B1 检测的经济结果。正在进行的研究应收集和报告与药物遗传学利益相关者相关的结局。
