The emergence, implementation, and future growth of pharmacogenomics in psychiatry: a narrative review

Psychological Medicine, Journal Year: 2023, Volume and Issue: 53(16), P. 7983 - 7993

Published: Sept. 29, 2023

Psychotropic medication efficacy and tolerability are critical treatment issues faced by individuals with psychiatric disorders their healthcare providers. For some people, it can take months to years of a trial-and-error process identify the ideal profile. Current strategies (e.g. clinical practice guidelines, algorithms) for addressing this issue be useful at population level, but often fall short individual level. This is, in part, attributed interindividual variation genes that involved pharmacokinetic (i.e. absorption, distribution, metabolism, elimination) pharmacodynamic receptors, signaling pathways) processes large determine whether will efficacious or tolerable. A precision prescribing strategy know as pharmacogenomics (PGx) assesses these genomic variations, uses inform selection dosing certain psychotropic medications. In review, we describe path led emergence PGx psychiatry, current evidence base implementation status clinic, finally, future growth potential psychiatry via convergence PGx-guided emerging technologies approaches pharmacoepigenomics, pharmacomicrobiomics, pharmacotranscriptomics, pharmacoproteomics, pharmacometabolomics) personalize disorders.

Language: Английский

---

Characterizing pharmacogenetic programs using the consolidated framework for implementation research: A structured scoping review

Frontiers in Medicine, Journal Year: 2022, Volume and Issue: 9

Published: Aug. 18, 2022

Several healthcare organizations have developed pre-emptive pharmacogenetic testing programs, where is undertaken prior to the prescription of a medicine. This review characterizes barriers and facilitators which influenced development these programs. A bidirectional citation searching strategy identified relevant publications before standardized data extraction approach was applied. Publications were grouped by program synthesis using Consolidated Framework for Implementation Research (CFIR). 104 from 40 programs 4 multi-center initiatives. 26 (66%) based in United States 95% high-income countries. The heterogeneous their design scale. Characteristics Intervention, Inner Setting, Process domains referenced 92.5, 80, 77.5% respectively. positive institutional culture, leadership engagement, engaging stakeholders, use clinical champions frequently described as implementation. Clinician self-efficacy, lack stakeholder knowledge, cost intervention commonly cited barriers. Despite variation between there several similarities could be categorized via CFIR. These form resource planning highlighting key can leveraged promote successful

Language: Английский

---

An updated examination of the perception of barriers for pharmacogenomics implementation and the usefulness of drug/gene pairs in Latin America and the Caribbean

Frontiers in Pharmacology, Journal Year: 2023, Volume and Issue: 14

Published: May 11, 2023

Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx the Latin American and Caribbean (LAC) region remains scarce, with limited information some populations. Thus, extrapolations are complicated, especially mixed In this paper, we reviewed analyzed pharmacogenomic knowledge among LAC scientific clinical community examined barriers to application. We performed a search for publications trials worldwide evaluated contribution of LAC. Next, conducted regional structured survey that list 14 potential implementation biomarkers based their importance. addition, paired 54 genes/drugs was determine association between response genomic medicine. This compared previous 2014 assess progress region. The results indicated countries have contributed 3.44% total 2.45% PGx-related thus far. A 106 professionals from 17 answered survey. Six major groups were identified. Despite region's continuous efforts last decade, primary barrier same, "need guidelines, processes, protocols application pharmacogenetics/pharmacogenomics". Cost-effectiveness issues critical factors Items related reluctance clinicians currently less relevant. Based results, highest ranked (96%-99%) gene/drug pairs perceived as important CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic NUDT15/thiopurines, CYP2B6/efavirenz, CYP2C19/clopidogrel. conclusion, although global low field, relevant improvement has been observed perception usefulness tests biomedical drastically changed, raising awareness physicians, which suggests promising future applications

Language: Английский

---

Reimbursement of pharmacogenetic tests at a tertiary academic medical center in the United States

Frontiers in Pharmacology, Journal Year: 2023, Volume and Issue: 14

Published: Aug. 14, 2023

Introduction: Pharmacogenetics (PGx) has the potential to improve health outcomes but cost of testing is a barrier for equitable access. Reimbursement by insurance providers may lessen financial burden patients, extent which PGx claims are covered in clinical practice not been well-characterized literature. Methods: A retrospective analysis outpatient submitted payers tests from 1/1/2019 through 12/31/2021 was performed. reimbursement rate calculated and compared across specific test types (e.g., single genes, panel), payers, indication, year claim submitted. Results: total 1,039 were analyzed. The overall 46% ranged 36%-48% payers. panels reimbursed at significantly higher than gene (74% vs. 43%, p < 0.001). Discussion: variable based on type, submitted, number diagnosis codes unique Due highly nature reimbursement, affordability should be discussed with each patient.

Language: Английский

---

QPGx‐CARES: Qatar pharmacogenetics clinical applications and research enhancement strategies

Clinical and Translational Science, Journal Year: 2024, Volume and Issue: 17(6)

Published: May 31, 2024

Pharmacogenetic (PGx)-informed medication prescription is a cutting-edge genomic application in contemporary medicine, offering the potential to overcome conventional "trial-and-error" approach drug prescription. The ability use an individual's genetic profile predict responses allows for personalized and dosage selection, thereby enhancing safety efficacy of treatments. However, despite significant scientific clinical advancements PGx, its integration into routine healthcare practices remains limited. To address this gap, Qatar Genome Program (QGP) has embarked on ambitious initiative known as QPGx-CARES (Qatar Pharmacogenetics Clinical Applications Research Enhancement Strategies), which aims set roadmap optimizing PGx research implementation national scale. goal integrate testing settings with aim improving patient health outcomes. In 2022, QGP initiated several projects various settings. These aimed evaluate utility testing, gather valuable insights effective dissemination data professionals patients, identify gaps challenges wider adoption. strategy evidence-based findings practice, focusing implementing cardiovascular medications, supported by robust evidence. current sets precedent nationwide precision medicine across diverse domains.

Language: Английский

---

Exploring perceived barriers and attitudes in young adults towards antidepressant pharmacotherapy, including the implementation of pharmacogenetic testing to optimize prescription practices

Frontiers in Pharmacology, Journal Year: 2025, Volume and Issue: 15

Published: Jan. 3, 2025

The field of pharmacogenetics (PGx) is experiencing significant growth, with increasing evidence to support its application in psychiatric care, suggesting potential personalize treatment plans, optimize medication efficacy, and reduce adverse drug reactions. However, the perceived utility practicability PGx for youth remains underexplored. This study investigated barriers attitudes Australian young adults towards implementation testing guide antidepressant primary care. Semi-structured focus groups interviews were conducted 17 participants aged between 18 24 years. These sessions recorded transcribed before thematic analysis was used identify collective themes. Three key themes identified, including prescription process, concerns testing, clinical implementation. Although positively by most participants, all shared about testing. Participants voiced financial impact delays, accuracy guiding treatment. Additionally, noted that low awareness willingness general practitioners incorporate into routine practice could hinder successful Prior practices, it essential acknowledge patient perspectives ensure practices remain patient-focused. highlights important considerations integrating pharmacotherapy emphasizes need future research address mitigate adults.

Language: Английский

---

Solanidine‐derived CYP2D6 phenotyping elucidates phenoconversion in multimedicated geriatric patients

British Journal of Clinical Pharmacology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 16, 2025

Abstract Aims Phenoconversion, a genotype‐phenotype mismatch, challenges successful implementation of personalized medicine. The aim this study was to detect and determine phenoconversion using the solanidine metabolites 3,4‐seco‐solanidine‐3,4‐dioic acid (SSDA) 4‐OH‐solanidine as diet‐derived cytochrome P450 2D6 (CYP2D6) biomarkers in geriatric, multimorbid cohort with high levels polypharmacy. Methods Blood samples data multimedicated patients were collected during physician counsel (CT: NCT05247814). Solanidine its determined via liquid chromatography/tandem mass spectrometry used for CYP2D6 phenotyping. genotyping performed activity scores (AS) assigned. Complete medication intake assessed. A shift AS predicted measured by phenotyping calculated. Results 88 complete documentation drug use. Patients had median age 83 years (interquartile range [IQR] 77‐87) majority (70.5%, n = 62) female. took 15 (IQR 12‐17) medications. SSDA/solanidine metabolic ratio correlated significantly genotyping‐derived ( P < .001) clearly detected poor metabolizers. In model adjusted age, sex, Charlson Comorbidity Index estimated glomerular filtration rate each additional substrate/inhibitor lowered expected 0.53 (95% confidence interval 0.85‐0.21) points encoding functional variants R 2 0.242). Conclusions Phenotyping measurement elucidates geriatric patients. These results might serve prerequisite validation establishment bedside method measure application prescribing.

Language: Английский

---

A feasibility study on implementing pre-emptive pharmacogenomics testing in outpatient clinics in Singapore (IMPT study)

The Pharmacogenomics Journal, Journal Year: 2025, Volume and Issue: 25(1-2)

Published: March 12, 2025

Abstract In view of the limited data related to preemptive pharmacogenomics (PGx) testing in primary care setting, we designed a study assess feasibility implementing PGx services at outpatient clinics, with aim practicality and challenges within care, its impact on clinical workflows patient care. This prospective was conducted between October 2022 August 2023 five clinics located Singapore. Patients aged 21 65 reported history or risk developing any target chronic conditions patients receiving one 29 PGx-associated medications were recruited. Patients’ buccal samples processed using multi-gene qPCR-based panel allele variants pharmacogenes. Surveys administered participants clinicians their perceptions outcomes testing. Among 222 patients, 95% had least clinically actionable variant. Of these 113 taking studied drugs, 21.2% them recommendation based results. A total 150 (67.6%) participated post-test follow-up survey. them, 70% expressed feeling relieved happy upon test reports increased confidence prescribed medication. Furthermore, identified necessity for clearer legal regulations regarding insurance coverage enhance future adoption Given high prevalence almost all tested this underscores benefits Clinical Trial Registration: is registered ClinicalTrials.gov, identifier NCT05504135, registration date 17, 2022.

Language: Английский

---

Pharmacogenomic testing: perception of clinical utility, enablers and barriers to adoption in Australian hospitals

Internal Medicine Journal, Journal Year: 2022, Volume and Issue: 52(7), P. 1135 - 1143

Published: Feb. 22, 2022

Despite healthcare professionals (HCP) endorsing the clinical utility of pharmacogenomics testing, use in practice is limited.To assess HCP' perceptions pharmacogenomic testing and identify barriers to implementation.HCP involved prescribing decisions at three hospitals Sydney, Australia, were invited participate. The online survey assessed including: (i) demographic variables; (ii) use, knowledge confidence; (iii) perceived benefits; (iv) implementation; (v) operational and/or system changes personnel required implement on site.HCP predominantly medical practitioners (75/107) pharmacists (25/107). HCP was beneficial reasons for drug intolerance (85/95) risk side-effects (86/95). Although considered relevant their (79/100), few (23/100) reported past or intended future (26/100). Few confidence ability indications (14/107), order tests (19/106) communicate results with patients (16/107). Lack guidelines (62/79) (54/77) identified as major implementation pharmacogenomics. Comprehensive reimbursement guidelines, alongside models-of-care involving multidisciplinary teams local champions suggested strategies facilitate into practice.Pharmacogenomic important guide selection dosing decisions. However, limited knowledge, low an absence impede testing. Establishment resources including

Language: Английский

---

The Critical Role of Pharmacists in the Clinical Delivery of Pharmacogenetics in the U.S

Pharmacy, Journal Year: 2023, Volume and Issue: 11(5), P. 144 - 144

Published: Sept. 10, 2023

Since the rebirth of pharmacogenomics (PGx) in 1990s and 2000s, with new discoveries genetic variation underlying adverse drug response analytical technologies such as sequencing microarrays, there has been much interest clinical application PGx testing. The early involvement pharmacists studies establishment organizations to support dissemination information about variants have naturally resulted leaders implementation. This paper presents an overview evolving role pharmacists, discusses potential challenges future paths, primarily focused U.S. Pharmacists positioned themselves testing, will prepare next generation utilize testing their scope practice.

Language: Английский

---