PHARMACOGENETICS AND PERSONALIZED THERAPY FROM GENOTYPE TO DRUG SELECTION

Abstract

The aim of the work was to evaluate the clinical and organizational usefulness of pharmacogenetic testing when choosing therapy in adult patients of a multidisciplinary clinic in Novosibirsk.

The study was based on an analysis of 200 observations, which simulates the real flow of cardiometabolic patients and four frequent prescribing situations: clopidogrel, warfarin, statins and metoprolol. The analysis included CYP2C19, CYP2C9, VKORC1, SLCO1B1 and CYP2D6.

Two comparable subgroups were compared: genotype-based treatment (n=100) and a standard regimen without a doctor's access to test results (n=100). A clinically significant pharmacogenetic profile was found in 80 patients, which accounted for 40.0% of the sample. The genotype-based recommendation was formed in 41.0% of patients in the main subgroup and implemented in 95.1% of cases. By week 12, a composite drug-associated endpoint was registered in 18.0% of patients versus 34.0% in the standard management group. The proportion of patients who reached the target clinical parameter by week 8 was 71.0% and 52.0%, respectively.

The most noticeable clinical benefit was observed in the routes of clopidogrel and warfarin, where the genotype changed the choice of the drug or the starting dose.

The obtained materials show that the practical value of pharmacogenetics is related not only to the laboratory result, but also to the speed of issuing an opinion, a single interpretation scheme, the participation of a clinical pharmacologist and the willingness of the doctor to change the initial appointment.