Clinical Application Of Pharmacogenomics Research Articles

A systematic review and meta-analysis of the impacts of germline pharmacogenomics on severe toxicity and symptom burden in adult patients with cancer.

The clinical application of Pharmacogenomics (PGx) has improved patient safety. However, comprehensive PGx testing has not been widely adopted in clinical practice, and significant opportunities exist to further optimize PGx in cancer care. This systematic review and meta-analysis aim to evaluate the safety outcomes of reported PGx-guided strategies (Analysis 1) and identify well-studied emerging pharmacogenomic variants that predict severe toxicity and symptom burden (Analysis 2) in patients with cancer. We searched MEDLINE, EMBASE, CENTRAL, clinicaltrials.gov, and International Clinical Trials Registry Platform from inception to January 2023 for clinical trials or comparative studies evaluating PGx strategies or unconfirmed pharmacogenomic variants. The primary outcomes were severe adverse events (SAE; ≥ grade 3) or symptom burden with pain and vomiting as defined by trial protocols and assessed by trial investigators. We calculated pooled overall relative risk (RR) and 95% confidence interval (95%CI) using random effects models. PROSPERO, registration number CRD42023421277. Of 6811 records screened, six studies were included for Analysis 1, 55 studies for Analysis 2. Meta-analysis 1 (five trials, 1892 participants) showed a lower absolute incidence of SAEs with PGx-guided strategies compared to usual therapy, 16.1% versus 34.0% (RR = 0.72, 95%CI 0.57-0.91, p = 0.006, I2 = 34%). Meta-analyses 2 identified nine medicine(class)-variant pairs of interest across the TYMS, ABCB1, UGT1A1, HLA-DRB1, and OPRM1 genes. Application of PGx significantly reduced rates of SAEs in patients with cancer. Emergent medicine-variant pairs herald further research into the expansion and optimization of PGx to improve systemic anti-cancer and supportive care medicine safety and efficacy.

Pharmacogenomics knowledge within Neurology: A brief survey amongst physicians

Pharmacogenomics has emerged as a tool to optimise treatment. Many neurologists encounter drugs with pharmacogenomic associations with unclear guidelines. We therefore aimed to determine the knowledge, attitudes, and barriers to implementing pharmacogenomics in clinical practice within a neurology unit. We developed and administered a survey on pharmacogenomics to physicians working in a neurology unit. Three drug-gene pairs clinically relevant to neurology were presented as case scenarios to assess physicians’ perceived competency, attitudes, and risks towards pharmacogenomics. Thirty-two (27.4%) physicians responded to the survey. Respondents were most confident about activities involving the HLA-B*15:02 test, followed by the CYP2C19 test, and lastly the CYP2C9 test. However, perceived competency in drug-drug-gene interactions was consistently low for all three tests. Referring to the product information leaflet ranked highest in usefulness, followed by local practice guidelines. In conclusion, local clinical guidelines and training on the clinical applications of pharmacogenomics are important to facilitate the implementation of pharmacogenomics.

Progress and problem in the clinical application of pharmacogenomics

With the emergence of various diseases, the use of clinical drugs has become common. Previously, a lot of unreasonable drug use increasingly becomes a serious concern, especially when the efficacy of drugs can’t be maximized and side effects can’t be minimized. In recent years, pharmacogenomics has effectively helped physicians and pharmacists predict drug efficacy and estimate drug dose by correlating individual genetic information with drug kinetics and pharmacodynamics. In addition, it is helpful to adjust drug administration regimens in time and prevent the occurrence of adverse drug reactions, to guide patients to use drugs rationally. This review analyzes the latest progress and outstanding problems in the clinical application of pharmacogenomics in order to provide a reference for its rational clinical application and promotion.

Pharmacogenomics in Older Adults: An Integrative Review.

Through pharmacogenomics testing, identifying genetic variants that influence how individuals respond to medications could potentially decrease the "trial and error" approach to prescribing medications, maximize beneficial effects, and reduce risks of adverse drug events. Yet, pharmacogenomics testing is still subject to an ongoing debate over its clinical validity and utility. The purpose of the current integrative review was to examine and synthesize evidence on the clinical application of pharmacogenomics in medication management among older adults. Gaps were found, such as lack of studies investigating the prospective use of pharmacogenomics testing to improve clinical outcomes and lack of strong evidence on the clinical validity and utility of pharmacogenomics testing in the medication management of older adults. However, the review identified evidence for the potential benefits of pharmacogenomics testing to improve older adults' clinical outcomes that warrant further investigation. [Research in Gerontological Nursing, 14(4), 211-220.].

Pharmacogenomics in Psychiatric Disorders

The broad arsenal of psychotropic medications is characterised by significant interindividual variability in clinical response and adverse effects, stringent monitoring requirements, potential drug-drug interactions, difficult long-term adherence and high costs. Pharmacogenomics investigates the correlation between genetic polymorphisms and responsiveness to drugs and could provide a valuable guide to fulfill the promise of personalized therapy in the context of the genomic medicine era, by tailoring treatment based on the patient’s specific genetic markers. The present paper overviews the current advances in the clinical applications of pharmacogenomics to individualized psychotropic therapy. Material and methods. The relevant recent pharmacogenomics literature is selected and analysed in order to illustrate the impact on the clinical outcomes and quality of life in psychiatric patients of the genetic variants in the neurotransmitter receptors (dopamine and serotonin), metabolic pathways of drugs (cytochrome CYP450 2D6 and 2C19) and the human leukocyte antigen system. The paper focuses on some of the major psychotropic drug classes, such as: antipsychotics, antidepressants and mood stabilizers. Validation of statistically significant pharmacogenomics relationships has enabled the development and market approval of some predictive tests which are already integrated into some psychotropic drugs label. Results and discussions. Predictive pharmacogenomics tests have changed the classical approach of prescription “trial-and error” and “one dose fits all patients” towards personalized therapy. In addition, in new therapeutic candidates’ clinical development, pharmacogenomics practically guides the clinical studies design, by substantially reducing the failure rates, costs and exposure risks of non-responders patients to new drugs. Current translation barriers of predictive pharmacogenomic tests from bench to clinical practice are also discussed. Conclusion. The paper emphasizes the current progress and future prospects in the field of pharmacogenomics as a guide to personalized therapy of psychiatric disorders, by: a) pretreatment selection of the right drug, prescribed in its optimized dose, to the right patient, according to one’s specific genetic biomarkers; b) by improved clinical trials design based on genetic stratification of patients’ population into responders versus non-responders, especially in the costly phases III and IV.

Academic and professional pharmacy education: a pharmacogenomics certificate training program.

The aim of this study was to evaluate a pharmacogenomics certificate training program relative to pharmacist competencies in basic genetic concepts, genetics and disease, pharmacogenetics/pharmacogenomics and ethical, legal and social implication. Participants, including pharmacists, pharmacy students and pharmacy educators completed a survey related to to the competency statements. Following the pre-program survey, participants completed a 6-week home self-study with subject matter including basic science (three chapters) and clinical application of pharmacogenomics (eight chapters). The participants completed a quiz for each of the self-study chapters. Following the self-study, participants completed a day-long, 7-h live program which included a review of the competency statements and counseling sessions with seven different simulated patients (primarily pharmacy students). Participants then completed a post-program survey which included the same items as the pre-program survey. Specifically, for the pharmacist participants, the average score of the self-study quizzes was 91%. For the pharmacists specifically, there was a statistically significant increase in self-assessed perception of competence related to pharmacogenomics. Additionally, it was observed that recommendations related to specific drug-gene interactions for the simulated patients were addressed correctly 95% of the time across all participant-patient encounters. Self-study and a live, interactive component in the certificate training program led to increased self-understanding of defined pharmacogenomics competencies. Additionally, pharmacy students, in the role of simulated patients gained knowledge during the live component of the program. This type of program, especially if made available through electronic-based platforms can serve to educate pharmacists and increase the uptake of pharmacogenomics in various healthcare settings.

Clinical application of pharmacogenomics in oncology

Clinical application of pharmacogenomics in oncology

Genomics into Healthcare: The 5th Pan Arab Human Genetics Conference and 2013 Golden Helix Symposium

The joint 5th Pan Arab Human Genetics conference and 2013 Golden Helix Symposium, "Genomics into Healthcare" was coorganized by the Center for Arab Genomic Studies (http://www.cags.org.ae) in collaboration with the Golden Helix Foundation (http://www.goldenhelix.org) in Dubai, United Arab Emirates from 17 to 19November, 2013. The meeting was attended by over 900 participants, doctors and biomedical students from over 50 countries and was organized into a series of nine themed sessions that covered cancer genomics and epigenetics, genomic and epigenetic studies, genomics of blood and metabolic disorders, cytogenetic diagnosis and molecular profiling, next-generation sequencing, consanguinity and hereditary diseases, clinical genomics, clinical applications of pharmacogenomics, and genomics in public health.

Meet a pharmacogenomics researcher

Jeffrey R. Bishop, PharmD, MS, BCPP, is an Assistant Professor at the University of Illinois at Chicago (UIC), Department of Pharmacy Practice and Department of Psychiatry. He received his Doctor of Pharmacy and Masters in Clinical Investigation from the University of Iowa. He completed a post-doctoral fellowship in pharmacogenetics and psychopharmacology at the same institution. Dr. Bishop will be presenting Understanding Genetic Variability and Pharmacogenomic Studies in Psychiatry at the 2012 CPNP Annual Meeting in Tampa, Florida.At UIC, Dr. Bishop acts as an investigator in the Pharmacogenetics Laboratory and Center for Cognitive Medicine. His primary focus is research, although he sets time aside for teaching and clinical work. His position gives him the creative freedom to ask and answer questions that may help our understanding of how medicines work in individual patients. Primarily, his research involves treatment of schizophrenia and bipolar disorder, but he also participates in collaborative research with ADHD and antidepressant pharmacogenomics. The overarching theme of the research is Personalized Medicine, with aims to identify why individuals have different outcomes from treatments and how symptoms may differ based on genetic factors. This type of research resonates with patients and families seeking answers to these same questions. Many individuals have experienced difficulty finding medications that ‘work for them.’ Dr. Bishop hopes the progress made in pharmacogenomics research will one day translate from the laboratory into clinical applications for direct patient care.As an active member of CPNP, Dr. Bishop has been part of the research committee for a number of years. He is involved with the abstracts, awards, and poster session activities at the CPNP Annual Meeting and is always excited to see an increase in the number of abstracts being presented. Dr. Bishop is also a member of the American Association of Colleges of Pharmacy and the American College of Clinical Pharmacy. Outside of pharmacy, he regularly attends meetings of the American College of Neuropsychopharmacology and International Congress on Psychiatric Research.For newer-trainees interested in pharmacogenomics research, Dr. Bishop recommends pursuing fellowships like those offered at UIC, or PhD programs in the field. For clinicians in established practices, self-directed education and attending pharmacogenomics CE sessions are alternatives to increase their knowledge of the field. Attending the exciting pharmacogenomic programming at the upcoming CPNP Annual Meeting will provide a background into the science and clinical application of pharmacogenomics in psychiatry. Another option is becoming a clinical collaborator in a pharmacogenomic study. This would be an avenue to get involved in pharmacogenomic research and learn more through practical experience.Dr. Bishop gives credit for his professional success to the people around him and for those who have served as mentors during his training and as a junior faculty member. He is very thankful for the mentorship and education he has received. He realizes the importance of surrounding himself with smart, genuine people who care about others. This helps make the hard work and long hours easier. Much credit is also given to his family for all of their support. This personal and professional support helps provide an environment where Dr. Bishop is happy and feels he is headed in a positive direction.

Is Pharmacogenomics Ready for Prime Time?

Although there is a large body of data available on clinical and translational pharmacogenomics, the clinical use is still very limited. This editorial will address why the clinical application of pharmacogenomics is not widely adopted and how to promote the use of pharmacogenomic knowledge in clinical practice. Pharmacogenomics has the potential of changing the pipeline model of drug discovery, clinical development, and mass customization marketing. Although there are established techniques for molecular genotyping and phenotyping in major research institutes, the facilities for genetic testing and measurement of drug and its metabolite concentrations are not always accessible in the diagnostic laboratory. What’s more, mutational screening using the current state-of-the-art technology is still laborious and time-consuming. Furthermore, the lack of adequate education provided to physicians in clinical practice as well as medical students and trainee physicians and it is yet to be incorporated into the curriculum of medical courses worldwide.

Integrating pharmacogenomics into pharmacy practice via medication therapy management: American Pharmacists Association

ObjectiveTo explore the application and integration of pharmacogenomics in pharmacy clinical practice via medication therapy management (MTM) to improve patient care. Data sourcesDepartment of Health & Human Services (HHS) Personalized Health Care Initiative, Food and Drug Administration (FDA) pharmacogenomics activity, and findings from the Utilizing E-Prescribing Technologies to Integrate Pharmacogenomics into Prescribing and Dispensing Practices Stakeholder Workshop, convened by the American Pharmacists Association (APhA) on March 5, 2009. Participants at the Stakeholder Workshop included diverse representatives from pharmacy, medicine, pathology, health information technology (HIT), standards, science, academia, government, and others with a key interest in the clinical application of pharmacogenomics. SummaryIn 2006, HHS initiated the Personalized Health Care Initiative with the goal of building the foundation for the delivery of gene-based care, which may prove to be more effective for large patient subpopulations. In the years since the initiative was launched, drug manufacturers and FDA have begun to incorporate pharmacogenomic data and applications of this information into the drug development, labeling, and approval processes. New applications and processes for using this emerging pharmacogenomics data are needed to effectively integrate this information into clinical practice. Building from the findings of a stakeholder workshop convened by APhA and the advancement of the pharmacist's collaborative role in patient care through MTM, emerging roles for pharmacists using pharmacogenomic information to improve patient care are taking hold. Realizing the potential role of the pharmacist in pharmacogenomics through MTM will require connectivity of pharmacists into the electronic health record infrastructure to permit the exchange of pertinent health information among all members of a patient's health care team. Addressing current barriers, concerns, and system limitations and developing an effective infrastructure will be necessary for pharmacogenomics to achieve its true potential. ConclusionTo achieve integration of pharmacogenomics into clinical practice via MTM, the pharmacy profession must define a process for the application of pharmacogenomic data into pharmacy clinical practice that is aligned with MTM service delivery, develop a viable business model for these practices, and encourage and direct the development of HIT solutions that support the pharmacist’s role in this emerging field.

Clinical applications of pharmacogenomics guided warfarin dosing

To assess the state of the literature concerning pharmacogenomic testing in patients requiring vitamin K antagonists, specifically warfarin. We conducted a literature search of MEDLINE and International Pharmaceutical Abstracts using the following words: warfarin, pharmacogenetic, and pharmacogenomic. The search results were reviewed by the authors and papers concerning pharmacogenomic testing in warfarin dosing were procured and reviewed. Additionally bibliographies of papers procured were also examined for other studies. The authors focused on clinical trials concerning the use of pharmacogenomic testing in warfarin dosing. Although numerous studies have demonstrated that a significant portion of warfarin dosing variability can be explained by genetic polymorphisms, few prospective studies have been conducted that examine the integration of this information in practical dosing situations. Those that have, have shown that using pharmacogenomic information improves initial dosing estimates and decreases the need for frequent clinic visits and laboratory testing. Data showing a reduction in serious bleeding events is sparse. Cost-effectiveness analyses have generally shown a small but positive effect with pharmacogenomic testing in patients receiving warfarin. Several studies have shown that pharmacogenomic testing for warfarin dosing is more accurate that other dosing schemes. Pharmacogenomic testing improves time to a therapeutic international normalized ratio while requiring fewer dosing adjustments. Patients who require higher or lower than usual doses seem to benefit the most. The cost-effectiveness of pharmacogenomic testing as well as preventing of outcomes such as bleeding or thrombosis are not yet elucidated. Pharmacists, especially those in a community setting can play a role in this new technology by educating prescribers and patients concerning pharmacogenomic testing, and by developing and using dosing protocols that incorporate its use.

Clinical applications of pharmacogenomics to adverse drug reactions

The problem of adverse drug reactions is a well-documented global public health problem. Recent withdrawals of several widely used prescription medications in the USA and other countries have raised concerns among patients, clinicians, scientists and policy makers. The increasing interest and concern regarding withdrawal of previously approved prescription medications and drug safety has prompted renewed research efforts aimed at improving surveillance of approved drugs and reducing adverse drug reactions. Pharmacogenomics research is increasingly directed at developing genomic diagnostics and tests with predictive ability for adverse drug reactions. This paper focuses on the problem of adverse drug reactions and reviews the evidence and the state of the science for the application of pharmacogenomics to adverse drug reactions.

Clinical applications of pharmacogenomics in head and neck cancer

Clinical applications of pharmacogenomics in head and neck cancer

Clinical application of pharmacogenomics

Clinical application of pharmacogenomics