Por Elaine D, Selig Daniel J, Chin Geoffrey C, DeLuca Jesse P, Oliver Thomas G, Livezey Jeffrey R
Experimental Therapeutics, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA.
Division of Clinical Pharmacology and Medical Toxicology, Uniformed Services University, Bethesda, MD 20814, USA.
Mil Med. 2021 Dec 30;187(Suppl 1):1-8. doi: 10.1093/milmed/usab098.
Pharmacogenomics (PGx) plays a fundamental role in personalized medicine, providing an evidence-based treatment approach centered on the relationship between genomic variations and their effect on drug metabolism. Cytochrome P450 (CYP450) enzymes are responsible for the metabolism of most clinically prescribed drugs and a major source of variability in drug pharmacokinetics and pharmacodynamics. To assess the prevalence of PGx testing within the Military Health System (MHS), testing of specific CYP450 enzymes was evaluated. Data were retrospectively obtained from the Military Health System Management Analysis and Reporting Tool (M2) database. Patient demographics were identified for each test, along with TRICARE status, military treatment facility, clinic, and National Provider Identifier. A total of 929 patients received 1,833 PGx tests, predominantly composed of active duty/guard service members (N = 460; 49.5%), with highest testing rates in the army (51.5%). An even distribution in testing was observed among gender, with the highest rates in Caucasians (41.7%). Of the CYP enzymes assessed, CYP2C19 and CYP2D6 accounted for 87.8% of all PGx CYP testing. The majority of patients were tested in psychiatry clinics (N = 496; 53.4%) and primary care clinics (N = 233; 25.1%), accounting for 56.4% and 24.8% of all tests, respectively. Testing was found to be provider driven, suggesting a lack of a standardized approach to PGx and its application in patient care within the MHS. We initially recommend targeted education and revising testing labels to be more uniform and informative. Long-term recommendations include establishing pharmacy-driven protocols and point-of-care PGx testing to optimize patient outcomes.
药物基因组学（PGx）在个性化医疗中发挥着基础性作用，提供了一种基于证据的治疗方法，该方法以基因组变异及其对药物代谢的影响之间的关系为核心。细胞色素P450（CYP450）酶负责大多数临床处方药的代谢，是药物药代动力学和药效学变异性的主要来源。为了评估军事卫生系统（MHS）内PGx检测的普及率，对特定CYP450酶的检测进行了评估。数据是从军事卫生系统管理分析和报告工具（M2）数据库中回顾性获取的。为每次检测确定了患者人口统计学信息，以及TRICARE状态、军事治疗机构、诊所和国家提供者标识符。共有929名患者接受了1833次PGx检测，主要由现役/国民警卫队成员组成（N = 460；49.5%），陆军的检测率最高（51.5%）。在性别方面观察到检测分布均匀，白种人的检测率最高（41.7%）。在所评估的CYP酶中，CYP2C19和CYP2D6占所有PGx CYP检测的87.8%。大多数患者在精神科诊所（N = 496；53.4%）和初级保健诊所（N = 233；25.1%）接受检测，分别占所有检测的56.4%和24.8%。发现检测是由提供者推动的，这表明在MHS内缺乏PGx的标准化方法及其在患者护理中的应用。我们最初建议进行有针对性的教育，并修订检测标签，使其更加统一和信息丰富。长期建议包括制定由药房驱动的方案和即时PGx检测，以优化患者治疗效果。
