Toward a clinical practice guide in pharmacogenomics testing for functional polymorphisms of drug-metabolizing enzymes. Gene/drug pairs and barriers perceived in Spain

Abstract

The development of clinical practice recommendations or guidelines for the clinical use of biomarkers is an issue of great importance with regard to adverse drug reactions. The potential of pharmacogenomic biomarkers has been extensively investigated in recent years. However, several barriers to implementing the use of pharmacogenomics testing exist. We conducted a survey among members of the Spanish Societies of Pharmacology and Clinical Pharmacology to obtain information about the perception of such barriers and to compare the perceptions of participants about the relative importance of major gene/drug pairs. Of 11 potential barriers, the highest importance was attributed to lack of institutional support for pharmacogenomics testing, and to the issues related to the lack of guidelines. Of the proposed gene/drug pairs the highest importance was assigned to HLA-B/abacavir, UGT1A1/irinotecan, and CYP2D6/tamoxifen. In this perspective article, we compare the relative importance of 29 gene/drug pairs in the Spanish study with that of the same pairs in the American Society for Clinical Pharmacology and Therapeutics study, and we provide suggestions and areas of focus to develop a guide for clinical practice in pharmacogenomics testing.

Keywords: adverse drug reactions; biomarkers; clinical recommendations; clinical relevance; pharmacogenomics.

FIGURE 1

Highest-ranking barriers to implementing the use of pharmacogenomics testing, based on a survey of Spanish Societies for Pharmacology and Clinical Pharmacology members in 2012. Data related to average importance (on a scale of 1–10) are plotted along the x-axis.

FIGURE 2

Highest-ranking gene/drug pairs, based on a survey of Spanish Societies for Pharmacology and Clinical Pharmacology members in 2012 (blue bars), compared to a published survey of American Society for Clinical Pharmacology and Therapeutics (ASCPT) members conducted by CPIC (red bars). Data related to the percentages of respondents who ranked the gene/drug pairs as 1 or 2 (on a scale of 1–5) are plotted along the y-axis.