An Analysis of Pharmacogenomic-Guided Pathways and Their Effect on Medication Changes and Hospital Admissions: A Systematic Review and Meta-Analysis.
An Analysis of Pharmacogenomic-Guided Pathways and Their Effect on Medication Changes and Hospital Admissions: A Systematic Review and Meta-Analysis.
复制标题
DOI：
10.3389/fgene.2021.698148
复制
发表时间：
2021
影响因子：
3.7
通讯作者：
Rattray M
中科院分区：
文献类型：
--
作者：
David V;Fylan B;Bryant E;Smith H;Sagoo GS;Rattray M
据估计，95%的人口携带至少一种与至少一种药物不一致的遗传变异。药物基因组学（PGx）检测有可能识别出具有遗传变异的患者，这些变异使他们面临药物不良反应和次优治疗的风险。预测患者对药物的反应可以支持药物的安全管理并减少住院治疗。只有处方临床医生根据PGx检测结果改变用药，才能实现这些益处。本综述探讨了PGx检测对住院的影响以及是否会促使药物治疗的变化。在三个数据库（Medline、CINAHL和EMBASE）中进行了系统检索，以检索截至2020年发表的所有相关研究，比较PGx检测患者与接受常规治疗（TAU）患者的住院率和药物变化。使用从纳入研究中开发的过程模型对从全文中提取的数据进行叙述性合成，以得出与PGx指导护理的建议工作流程及其对药物优化和住院治疗的预期获益相关的主题。对所有报告与接受TAU的受试者相比发生药物变化的PGx检测患者数量和住院的PGx检测患者数量的研究进行了荟萃分析。检索策略确定了5项住院主题研究和5项药物变更主题研究进行分析。荟萃分析显示，在5项研究中的4项中，PGx试验组的药物变化发生频率显著更高。荟萃分析显示，PGx试验组的全因住院发生率显著低于TAU。结果显示了在处方中使用PGx的概念证明，可产生患者获益。然而，该综述还强调了在考虑将PGx引入卫生系统时重要的机会和证据差距;即患者参与PGx处方决策，从而更好地了解患者和处方者的观点。我们强调了在考虑将PGx引入卫生系统时重要的机会和证据差距。
Ninety-five percent of the population are estimated to carry at least one genetic variant that is discordant with at least one medication. Pharmacogenomic (PGx) testing has the potential to identify patients with genetic variants that puts them at risk of adverse drug reactions and sub-optimal therapy. Predicting a patient's response to medications could support the safe management of medications and reduce hospitalization. These benefits can only be realized if prescribing clinicians make the medication changes prompted by PGx test results. This review examines the current evidence on the impact PGx testing has on hospital admissions and whether it prompts medication changes. A systematic search was performed in three databases (Medline, CINAHL and EMBASE) to search all the relevant studies published up to the year 2020, comparing hospitalization rates and medication changes amongst PGx tested patients with patients receiving treatment-as-usual (TAU). Data extracted from full texts were narratively synthesized using a process model developed from the included studies, to derive themes associated to a suggested workflow for PGx-guided care and its expected benefit for medications optimization and hospitalization. A meta-analysis was undertaken on all the studies that report the number of PGx tested patients that had medication change(s) and the number of PGx tested patients that were hospitalized, compared to participants that received TAU. The search strategy identified 5 hospitalization themed studies and 5 medication change themed studies for analysis. The meta-analysis showed that medication changes occurred significantly more frequently in the PGx tested arm across 4 of 5 studies. Meta-analysis showed that all-cause hospitalization occurred significantly less frequently in the PGx tested arm than the TAU. The results show proof of concept for the use of PGx in prescribing that produces patient benefit. However, the review also highlights the opportunities and evidence gaps that are important when considering the introduction of PGx into health systems; namely patient involvement in PGx prescribing decisions, thus a better understanding of the perspective of patients and prescribers. We highlight the opportunities and evidence gaps that are important when considering the introduction of PGx into health systems.
登录
查看更多内容
影响因子：
2.8
作者：
Kirchheiner, J.;Schmidt, H.;Brockmoeller, J.
通讯作者：
Brockmoeller, J.
影响因子：
3.7
作者：
Elliott LS;Henderson JC;Neradilek MB;Moyer NA;Ashcraft KC;Thirumaran RK
通讯作者：
Thirumaran RK
影响因子：
1.9
作者：
Ielmini, Marta;Poloni, Nicola;Callegari, Camilla
通讯作者：
Callegari, Camilla
影响因子：
2.3
作者：
Mai, Yuan;Mitropoulou, Christina;Patrinos, George P.
通讯作者：
Patrinos, George P.
影响因子：
2.4
作者：
Brixner, D.;Biltaji, E.;Biskupiak, J.
通讯作者：
Biskupiak, J.