Pattanaik Smita, Gota Vikram, Tripathi Santanu Kumar, Kshirsagar Nilima A
Clinical Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Advanced Centre for Treatment Education and Research in Cancer, Tata Memorial Centre, Kharghar Navi Mumbai, India.
Br J Clin Pharmacol. 2023 Nov;89(11):3247-3261. doi: 10.1111/bcp.15808. Epub 2023 Aug 11.
Over the last three to four decades, Therapeutic Drug Monitoring (TDM) has shaped itself as therapeutic drug management, an integral component of precision medicine. The practice of TDM is not extensive in India, despite being one of the fastest-growing economies in the world. It is currently limited to a few academic medical centres and teaching hospitals. Apart from the immunosuppressive drugs, several other therapeutic areas, such as anticancer, antifungal, antibiotic and antitubercular, have demonstrated great potential to improve patient outcomes in Indian settings. Factors such as the higher prevalence of nutritional deficiencies, tropical diseases, widespread use of alternative medicines, unalike pharmacogenomics and sparse population-specific data available on therapeutic ranges of several drugs make the population of this subcontinent unique regarding the relevance of TDM. Despite the impact of TDM in clinical science and its widespread application, TDM has failed to receive the attention it deserves in India. This review intends to bring out a strength, weakness, opportunity and threats (SWOT) analysis for TDM in India so that appropriate steps for fostering the growth of TDM could be envisioned. The need of the hour is the creation of a cooperative group including all the stakeholders, such as TDM professionals, clinicians and the government and devising a National Action Plan to strengthen TDM. Nodal TDM centres should be established, and pilot programmes should be rolled out to identify the thrust areas for TDM in the country, capacity building and creating awareness to integrate TDM into mainstream clinical medicine.
在过去的三四十年里，治疗药物监测（TDM）已发展成为治疗药物管理，这是精准医学的一个重要组成部分。尽管印度是世界上增长最快的经济体之一，但TDM在印度的应用并不广泛。目前它仅限于少数学术医疗中心和教学医院。除了免疫抑制药物外，其他几个治疗领域，如抗癌、抗真菌、抗生素和抗结核领域，在印度的环境中已显示出改善患者治疗效果的巨大潜力。营养缺乏症患病率较高、热带疾病、替代药物的广泛使用、不同的药物基因组学以及几种药物治疗范围的特定人群数据稀少等因素，使得该次大陆人群在TDM的相关性方面具有独特性。尽管TDM在临床科学中有影响且应用广泛，但在印度它却未能得到应有的关注。本综述旨在对印度的TDM进行优势、劣势、机会和威胁（SWOT）分析，以便能够设想出促进TDM发展的适当步骤。当务之急是成立一个包括所有利益相关者（如TDM专业人员、临床医生和政府）的合作小组，并制定一项国家行动计划以加强TDM。应设立TDM节点中心，并开展试点项目，以确定该国TDM的重点领域、能力建设以及提高将TDM纳入主流临床医学的认识。
