Research and Clinical Implementation of Drug-Gene Interactions in Children

抄録

As momentum builds for precision medicine, one cornerstone of this personalized approach is pharmacogenomics. In adults, many clinicians have incorporated pharmacogenomic testing and genome-guided therapeutic decision making, either for routine prescribing of common drugs, or in the setting of specific circumstances such as serial therapeutic failures. The clinical implementation of pharmacogenomics in the care of pediatric patients lags behind that of adults, owing in large part to a lack of evidence supporting genome-guided therapy in this age group. There are several barriers to extrapolating data from adults or generating this evidence from studies in children. One is the distinct formulary of drugs used for children, many of which have not been interrogated for drug-gene associations. In addition, many drugs are used in children for pediatric-specific indications or with pediatric-specific side effect profiles. Furthermore, generation of convincing datasets is hindered by the small numbers of exposed pediatric patients and the variable impact of age on drug distribution and response. Several centers have developed innovative approaches to address these barriers, making strides in the use of clinical pharmacogenomics to provide personalized therapeutics to pediatric patients and in the investigation of drug-gene interactions in children.