Background

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.

Objective

The purpose of this review is to identify the evidence to date of PGx use in pharmacy practice.

Methods

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.

Results

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.

Conclusions

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.

中文翻译：

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药物基因组学在药学实践中的应用：范围审查

背景

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，没有评论全面地描绘了药剂师在基于实践的研究中使用 PGx 的情况。这样做将使未来的研究人员、从业人员和政策制定者能够确定在药房内实施 PGx 的理想人群和环境。

客观的

本综述的目的是确定迄今为止在药学实践中使用 PGx 的证据。

方法

进行了范围审查，以找到所有已研究的纳入 PGx 测试的非肿瘤药学实践。检索词应用于 5 个数据库和相关期刊。总结了患者的特征、药房设置、基因测试和结果，以确定最有可能使患者受益的模型。

结果

搜索确定了 2007 年至 2020 年间发表的 43 项药剂师使用 PGx 的研究。CYP2C19抗血小板测试是研究最多的模型，在社区和机构环境中都可以找到。这也是最可行的测试：大约 30% 的患者具有表明需要替代抗血小板药物的多态性，识别这些患者可以将发病率和死亡率降低 50% 以上。随着技术的转变，在 MTM 中使用多基因面板测试的更广泛研究表明，老年多药治疗患者的急诊就诊和住院治疗减少了大约 50%。在其他心血管、精神、镇痛和胃肠道适应症中也发现了临床益处或药物-基因相互作用。尚未对基于药房的 PGx 中的实际成本或药剂师处方进行评估。成功实施 PGx 的推动者包括药剂师教育、

结论

药物基因组学测试已经证明了药学实践中的可行性并改善了药物治疗效果，包括在社区药房中。进一步的 PGx 研究应针对药剂师处方、药剂师教育和药物经济学。