精确给药以避免药物不良反应。
Precision dosing to avoid adverse drug reactions.
作者信息
Polasek Thomas M, Kirkpatrick Carl M J, Rostami-Hodjegan Amin
机构信息
Certara, 100 Overlook Center, Suite 101, Princeton, NJ 08540 USA.
Centre for Medicines Use and Safety, Monash University, Melbourne, Australia.
出版信息
Ther Adv Drug Saf. 2019 Dec 11;10:2042098619894147. doi: 10.1177/2042098619894147. eCollection 2019.
Adverse drug reactions (ADRs) have traditionally been managed by trial and error, adjusting drug and dose selection reactively following patient harm. With an improved understanding of ADRs, and the patient characteristics that increase susceptibility, precision medicine technologies enable a proactive approach to ADRs and support clinicians to change prescribing accordingly. This commentary revisits the famous pharmacology-toxicology continuum first postulated by Paracelsus 500 years ago and explains why precision dosing is needed to help avoid ADRs in modern clinical practice. Strategies on how to improve precision dosing are given, including more research to establish better precision dosing targets in the cases of greatest need, easier access to dosing instructions e-prescribing, improved monitoring of patients with novel biomarkers of drug response, and further application of model-informed precision dosing.
传统上，药物不良反应（ADR）的处理方式是试错法，即在患者受到伤害后，被动地调整药物和剂量选择。随着对ADR以及增加易感性的患者特征有了更深入的了解，精准医学技术使我们能够对ADR采取主动应对措施，并支持临床医生相应地改变处方。本评论重新审视了500年前由帕拉塞尔苏斯首次提出的著名的药理学-毒理学连续统一体，并解释了为何在现代临床实践中需要精准给药以帮助避免ADR。文中给出了关于如何提高精准给药的策略，包括开展更多研究以在最需要的情况下确定更好的精准给药目标、通过电子处方更便捷地获取给药说明、利用新型药物反应生物标志物对患者进行更好的监测，以及进一步应用模型指导的精准给药。
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