RESUMEN
In this Perspective, the authors discuss the state of pharmacogenomics testing addressing a number of advances, challenges and barriers, including legal ramifications, changes to the regulatory landscape, coverage of testing and the implications of direct-to-consumer genetic testing on the provision of care to patients. Patient attitudes toward pharmacogenomics testing and associated costs will play an increasingly important role in test acquisition and subsequent utilization in a clinical setting. Additional key steps needed include: further research trials demonstrating clinical utility and cost-effectiveness of pharmacogenetic testing, evidence review to better integrate genomic information into clinical practice guidelines in target therapeutic areas to help providers identify patients that may benefit from pharmacogenetic testing and engagement with payers to create a path to reimbursement for pharmacogenetic tests that currently have sufficient evidence of clinical utility. Increased adoption of testing by payers and improved reimbursement practices will be needed to overcome barriers, especially as the healthcare landscape continues to shift toward a system of value-based care.
Asunto(s)
Pruebas Dirigidas al Consumidor/economía , Pruebas Dirigidas al Consumidor/legislación & jurisprudencia , Pruebas de Farmacogenómica/economía , Pruebas de Farmacogenómica/legislación & jurisprudencia , Medicina de Precisión/economía , Análisis Costo-Beneficio/economía , Análisis Costo-Beneficio/legislación & jurisprudencia , Etiquetado de Medicamentos/economía , Etiquetado de Medicamentos/legislación & jurisprudencia , Humanos , Mala Praxis/economía , Mala Praxis/legislación & jurisprudenciaAsunto(s)
Legislación de Dispositivos Médicos , Técnicas de Diagnóstico Molecular/métodos , Pruebas de Farmacogenómica/métodos , Medicina de Precisión/métodos , Biomarcadores , Unión Europea , Objetivos , Humanos , Técnicas In Vitro , Legislación de Dispositivos Médicos/organización & administración , Técnicas de Diagnóstico Molecular/instrumentación , Pruebas de Farmacogenómica/instrumentación , Pruebas de Farmacogenómica/legislación & jurisprudencia , Medicina de Precisión/instrumentaciónRESUMEN
Surveys among pharmacists and physicians show that these healthcare professionals have successfully adopted the concept of pharmacogenomics (PGx).1-3 In addition, patients are willing to consent to participate in PGx implementation studies.4 However, the surveys also show that healthcare professionals do not frequently order or recommend a PGx test.1,2 Among others, a frequently perceived hurdle for clinical uptake of PGx is the availability of guidelines translating PGx test results into clinical actions for individual patients.5,6.
Asunto(s)
Farmacogenética/legislación & jurisprudencia , Pruebas de Farmacogenómica/legislación & jurisprudencia , Europa (Continente) , Humanos , Farmacéuticos/legislación & jurisprudencia , Médicos/legislación & jurisprudenciaRESUMEN
Recommendations on genetic testing are typically conveyed by drug regulatory authorities through drug labels, which are legal requirements for market authorization of drugs. We conducted a cross-sectional study of drug labels focusing on three crucial aspects of regulatory pharmacogenomics communications: (i) intent; (ii) interpretation in the local context; and (iii) implications of the genetic information. Labels of drugs associated with well-established safety-related genetic markers for adverse drug reactions across six developed countries of United States, Canada, United Kingdom, Australia, New Zealand and Singapore were reviewed. We found differing medical advice for genotype-positive HLA-B*15:02, HLA-A*31:01, UGT1A1*28 and CYP2D6 ultra-rapid metabolisers in breastfeeding women. This raises questions on implications to clinical practice between these countries. Varying ways of presenting at-risk population and allele frequencies also raises question in incorporating such information in drug labels. An international guidance addressing these crucial aspects of regulatory pharmacogenomic communications in drug labels is long overdue.
Asunto(s)
Etiquetado de Medicamentos/legislación & jurisprudencia , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/genética , Farmacogenética/legislación & jurisprudencia , Variantes Farmacogenómicas , Australia , Lactancia Materna , Canadá , Consenso , Estudios Transversales , Citocromo P-450 CYP2D6/genética , Etiquetado de Medicamentos/normas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/enzimología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/inmunología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Glucuronosiltransferasa/genética , Antígenos HLA-A/genética , Antígeno HLA-B15/genética , Humanos , Nueva Zelanda , Seguridad del Paciente/legislación & jurisprudencia , Farmacogenética/normas , Pruebas de Farmacogenómica/legislación & jurisprudencia , Fenotipo , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Singapur , Reino Unido , Estados UnidosRESUMEN
PURPOSE: Both regulatory science and clinical practice rely on best available scientific data to guide decision-making. However, changes in clinical practice may be driven by numerous other factors such as cost. In this review, we reexamine noteworthy examples where pharmacogenetic testing information was added to drug labeling to explore how the available evidence, potential public health impact, and predictive utility of each pharmacogenetic biomarker impacts clinical uptake. SUMMARY: Advances in the field of pharmacogenetics have led to new discoveries about the genetic basis for variability in drug response. The Food and Drug Administration recognizes the value of pharmacogenetic testing strategies and has been proactive about incorporating pharmacogenetic information into the labeling of both new drugs and drugs already on the market. Although some examples have readily translated to routine clinical practice, clinical uptake of genetic testing for many drugs has been limited. CONCLUSION: Both regulatory science and clinical practice rely on data-driven approaches to guide decision making; however, additional factors are also important in clinical practice that do not impact regulatory decision making, and these considerations may result in heterogeneity in clinical uptake of pharmacogenetic testing.