Associate Professor of Pediatrics and Psychiatry, University of Connecticut School of Medicine, Division of Child and Adolescent Psychiatry, Institute of Living/Hartford Hospital, 200 Retreat Ave, Hartford, CT, 06019, USA.
Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06032, USA.
Curr Psychiatry Rep. 2020 May 6;22(5):26. doi: 10.1007/s11920-020-01145-4.
This paper aims to acquaint child and adolescent psychiatrists with the field of pharmacogenomics (PGX) and review the most up-to-date evidence-based practices to guide the application of this field in clinical care.
Despite much research being done in this area, the field of PGX continues to yield controversial findings. In the adult world, studies have focused on the impact of combinatorial gene panels that guide medication selection by providing reports that estimate the impact of multiple pharmacodynamic and pharmacokinetic genes, but to date, these have not been directly examined in younger patient populations. Pharmacokinetic genes, CYP2D6 and CYP2C19, and hypersensitivity genes, HLA-A and HLA-B, have the strongest evidence base for application to pharmacotherapy in children. Although the field is evolving, and the evidence is mixed, there may be a role for PGX testing in children to help guide dosing and monitoring strategies. However, evidence-based medicine, rather than PGX testing, continues to play the lead role in guiding medication selection in pediatric psychopharmacology.
本文旨在使儿童和青少年精神科医生了解药物基因组学（PGX）领域，并回顾最新的循证实践，以指导该领域在临床护理中的应用。
尽管该领域进行了大量研究，但 PGX 领域仍存在有争议的发现。在成人世界中，研究集中在组合基因面板的影响上，这些基因面板通过提供估计多种药效动力学和药代动力学基因影响的报告来指导药物选择，但迄今为止，这些报告尚未在年轻患者群体中直接进行检查。药代动力学基因 CYP2D6 和 CYP2C19 以及过敏基因 HLA-A 和 HLA-B 具有最强的应用于儿童药物治疗的证据基础。尽管该领域正在发展，并且证据存在分歧，但 PGX 测试可能在帮助指导儿童的剂量和监测策略方面发挥作用。然而，循证医学而不是 PGX 测试继续在指导儿科精神药理学中的药物选择中发挥主导作用。
