Clinical Pharmacology, St George's University Hospitals NHS Foundation Trust, London, UK.
Institute of Medical and Biomedical Education, St George's, University of London, UK.
Br J Clin Pharmacol. 2019 Dec;85(12):2734-2746. doi: 10.1111/bcp.14100. Epub 2019 Dec 13.
To investigate the longitudinal exposure of English primary care patients to pharmacogenomic drugs to inform design of pre-emptive testing.
Sixty-three drugs were identified with dosing guidelines based on variants of 19 pharmacogenes in the Pharmacogenomics Knowledgebase on 01 September 2018. Prescribing of these pharmacogenomic drugs between 1993 and 2017 was summarised for a sample of 648 141 English patients aged 50-99 years on 01 January 2013, registered with Clinical Practice Research Datalink practices during 2011-12. Exposure of patients to pharmacogenomic drugs retrospectively (2, 10, 20 y) and prospectively (5 y) was described.
During 2011-12, 58% of patients were prescribed at least 1 pharmacogenomic drug, increasing to 80% over the previous 20 years. Multiple exposure was common, with 47% patients prescribed ≥2 pharmacogenomic drugs and 7% prescribed ≥5 pharmacogenomic drugs over the next 5 years. The likelihood of exposure to pharmacogenomic drugs increased with age, with 89% patients ≥70 years prescribed at least 1 pharmacogenomic drug over the previous 20 years. Even among those aged 50-59 years, 71% were prescribed at least 1 pharmacogenomic drug over the previous 20 years. The pharmacogenomic drugs prescribed to the most patients were for pain relief, gastroprotection, psychiatric and cardiovascular conditions. Three pharmacogenes (CYP2D6, CYP2C19 and SLCO1B1) accounted for >95% pharmacogenomic drugs prescribed.
In primary care patients, exposure to pharmacogenomic drugs is extremely common, multiplicitous and has commenced by relatively early adulthood. A small number of pharmacogenes account for the majority of drugs prescribed. These findings could inform design of pre-emptive pharmacogenomic testing for implementation in primary care.
研究英国初级保健患者对药物基因组学药物的长期暴露情况，为抢先测试的设计提供信息。
2018 年 9 月 1 日，根据 Pharmacogenomics Knowledgebase 中 19 个药物基因组学基因的变异，确定了 63 种药物具有剂量指南。对 2011 年至 2017 年间在临床实践研究数据链（CPRD）实践中登记的 648141 名 50-99 岁的英国患者样本，于 2013 年 1 月 1 日进行了这些药物基因组学药物的处方总结。描述了患者对药物基因组学药物的回顾性（2、10、20 年）和前瞻性（5 年）暴露情况。
2011-12 年，58%的患者至少开了一种药物基因组学药物，在过去 20 年中增加到 80%。多药暴露很常见，47%的患者在接下来的 5 年中开了≥2 种药物基因组学药物，7%的患者开了≥5 种药物基因组学药物。随着年龄的增长，接触药物基因组学药物的可能性增加，在过去的 20 年中，89%的≥70 岁患者至少开了一种药物基因组学药物。即使在 50-59 岁的患者中，也有 71%的患者在过去的 20 年中至少开了一种药物基因组学药物。处方最多的药物基因组学药物用于缓解疼痛、胃保护、精神和心血管疾病。三个药物基因组学基因（CYP2D6、CYP2C19 和 SLCO1B1）占处方药物基因组学药物的 95%以上。
在初级保健患者中，接触药物基因组学药物非常普遍，而且是多药性的，并在相对较早的成年期就开始了。少数药物基因组学基因占处方药物的大多数。这些发现可以为在初级保健中实施抢先药物基因组学测试的设计提供信息。
