Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada; AbEx Health Services LTD, Fort Saskatchewan, Alberta, Canada.
Res Social Adm Pharm. 2022 Jul;18(7):3094-3118. doi: 10.1016/j.sapharm.2021.08.009. Epub 2021 Aug 20.
Pharmacogenomics (PGx) can provide valuable pharmacokinetic and pharmacodynamic information for the pharmacist's assessment of drug therapy, especially within medication therapy management (MTM) services. However, no review has comprehensively mapped the pharmacists' use of PGx in practice-based research. Doing so would allow future researchers, practitioners, and policy-makers to identify the ideal populations and settings for PGx implementation within the pharmacy.
The purpose of this review is to identify the evidence to date of PGx use in pharmacy practice.
A scoping review was conducted to find all studied non-oncologic pharmacy practices incorporating PGx testing. Search terms were applied to 5 databases and relevant journals. Characteristics of patients, pharmacy settings, genetic tests, and outcomes were summarized to determine models most likely to benefit patients.
The search identified 43 studies on the use of PGx by pharmacists published between 2007 and 2020. CYP2C19 testing with antiplatelets was the most studied model, found in both community and institutional settings. It also was the most actionable test: approximately 30% of patients have polymorphisms indicating a need for alternative antiplatelets, and identifying these patients can reduce morbidity and mortality by more than 50%. As technology shifts, broader studies using multi-gene panel tests within MTM demonstrate an approximate 50% decrease in emergency visits and hospitalizations in elderly polypharmacy patients. Clinical benefit or drug-gene interactions are also found in other cardiovascular, psychiatric, analgesic, and gastrointestinal indications. No evaluations of actual costs or of pharmacist prescribing within pharmacy-based PGx have been performed. Facilitators towards successful PGx implementation included pharmacist education, collaboration with other healthcare providers, and the use of clinical decision software.
Pharmacogenomic testing has demonstrated feasibility and improved medication outcomes in pharmacy practice, including in the community pharmacy. Further PGx research should be directed towards pharmacist prescribing, pharmacist education, and pharmacoeconomics.
药物基因组学（PGx）可以为药剂师评估药物治疗提供有价值的药代动力学和药效学信息，尤其是在药物治疗管理（MTM）服务中。然而，目前还没有综述全面描述药剂师在实践研究中使用 PGx 的情况。这样做可以让未来的研究人员、从业者和政策制定者确定在药房实施 PGx 的理想人群和环境。
本综述旨在确定迄今为止 PGx 在药房实践中的应用证据。
进行了范围综述，以查找所有纳入 PGx 检测的非肿瘤性药学实践研究。将检索词应用于 5 个数据库和相关期刊。总结患者、药房环境、遗传检测和结果的特征，以确定最有可能使患者受益的模型。
搜索确定了 2007 年至 2020 年间发表的 43 项关于药剂师使用 PGx 的研究。CYP2C19 检测与抗血小板药物的结合是研究最多的模型，在社区和机构环境中均有研究。它也是最具操作性的检测：大约 30%的患者存在表明需要替代抗血小板药物的多态性，识别这些患者可以使发病率和死亡率降低 50%以上。随着技术的转变，在 MTM 中使用多基因面板检测的更广泛研究表明，老年多药患者的急诊就诊和住院率降低了约 50%。在心血管、精神科、镇痛和胃肠道等其他适应症中也发现了临床获益或药物-基因相互作用。尚未对实际成本或药剂师在药房 PGx 中的处方进行评估。成功实施 PGx 的促进因素包括药剂师教育、与其他医疗保健提供者的合作以及临床决策软件的使用。
PGx 检测已在药学实践中（包括社区药房）证明了其可行性并改善了药物治疗效果。应进一步开展 PGx 研究，以探讨药剂师处方、药剂师教育和药物经济学问题。
