1
|
Martin A, Downing J, Maden M, Fleeman N, Alfirevic A, Haycox A, Pirmohamed M. An assessment of the impact of pharmacogenomics on health disparities: a systematic literature review. Pharmacogenomics 2017; 18:1541-1550. [PMID: 29095091 DOI: 10.2217/pgs-2017-0076] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This review assessed evidence of disparities in benefits of pharmacogenomics related to 'model performance' in subgroups of patients and studies which reported impact on health inequalities. 'Model performance' refers to the ability of algorithms including clinical, environmental and genetic information to guide treatment. A total of 4978 abstracts were screened by one reviewer and 30% (1494) were double screened by a second independent reviewer, after which data extraction was performed. Additional forward and backward citation searching of reference lists was conducted. Investigators independently double rated study quality and applicability of included studies. Only five individual studies were identified which met our inclusion criteria, but were contradictory in their conclusions. While three studies of genotype-guided dosing of warfarin reported that ethnic disparities in healthcare may widen, two other studies (one reporting on warfarin and reporting on clopidogrel) suggested that disparities in healthcare may reduce. There is a paucity of studies which evaluates the impact of pharmacogenomics on health disparities. Further work is required not only to evaluate health disparities between ethnic groups and countries but also within ethnic groups in the same country and solutions need to be identified to overcome these disparities.
Collapse
Affiliation(s)
- Antony Martin
- NIHR CLAHRC NWC Wolfson Centre for Personalised Medicine, University of Liverpool, Block A: Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Jennifer Downing
- NIHR CLAHRC NWC Wolfson Centre for Personalised Medicine, University of Liverpool, Block A: Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Michelle Maden
- NIHR CLAHRC NWC Wolfson Centre for Personalised Medicine, University of Liverpool, Block A: Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Nigel Fleeman
- Liverpool Reviews & Implementation Group, Universityof Liverpool, Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB, UK
| | - Ana Alfirevic
- NIHR CLAHRC NWC Wolfson Centre for Personalised Medicine, University of Liverpool, Block A: Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Alan Haycox
- Liverpool Health Economics, University ofLiverpool Management School, Chatham Street, Liverpool, L69 7ZH, UK
| | - Munir Pirmohamed
- NIHR CLAHRC NWC Wolfson Centre for Personalised Medicine, University of Liverpool, Block A: Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| |
Collapse
|
2
|
Jansen ME, Rigter T, Rodenburg W, Fleur TMC, Houwink EJF, Weda M, Cornel MC. Review of the Reported Measures of Clinical Validity and Clinical Utility as Arguments for the Implementation of Pharmacogenetic Testing: A Case Study of Statin-Induced Muscle Toxicity. Front Pharmacol 2017; 8:555. [PMID: 28878673 PMCID: PMC5572384 DOI: 10.3389/fphar.2017.00555] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/07/2017] [Indexed: 12/19/2022] Open
Abstract
Advances from pharmacogenetics (PGx) have not been implemented into health care to the expected extent. One gap that will be addressed in this study is a lack of reporting on clinical validity and clinical utility of PGx-tests. A systematic review of current reporting in scientific literature was conducted on publications addressing PGx in the context of statins and muscle toxicity. Eighty-nine publications were included and information was selected on reported measures of effect, arguments, and accompanying conclusions. Most authors report associations to quantify the relationship between a genetic variation an outcome, such as adverse drug responses. Conclusions on the implementation of a PGx-test are generally based on these associations, without explicit mention of other measures relevant to evaluate the test's clinical validity and clinical utility. To gain insight in the clinical impact and select useful tests, additional outcomes are needed to estimate the clinical validity and utility, such as cost-effectiveness.
Collapse
Affiliation(s)
- Marleen E Jansen
- Section Community Genetics, Department of Clinical Genetics and Amsterdam Public Health Research Institute, VU University Medical CenterAmsterdam, Netherlands.,Centre for Health Protection, National Institute for Public Health and the EnvironmentBilthoven, Netherlands
| | - T Rigter
- Section Community Genetics, Department of Clinical Genetics and Amsterdam Public Health Research Institute, VU University Medical CenterAmsterdam, Netherlands.,Centre for Health Protection, National Institute for Public Health and the EnvironmentBilthoven, Netherlands
| | - W Rodenburg
- Centre for Health Protection, National Institute for Public Health and the EnvironmentBilthoven, Netherlands
| | - T M C Fleur
- Section Community Genetics, Department of Clinical Genetics and Amsterdam Public Health Research Institute, VU University Medical CenterAmsterdam, Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht UniversityUtrecht, Netherlands
| | - E J F Houwink
- Section Community Genetics, Department of Clinical Genetics and Amsterdam Public Health Research Institute, VU University Medical CenterAmsterdam, Netherlands
| | - M Weda
- Centre for Health Protection, National Institute for Public Health and the EnvironmentBilthoven, Netherlands
| | - Martina C Cornel
- Section Community Genetics, Department of Clinical Genetics and Amsterdam Public Health Research Institute, VU University Medical CenterAmsterdam, Netherlands
| |
Collapse
|
3
|
Kapoor R, Tan-Koi WC, Teo YY. Role of pharmacogenetics in public health and clinical health care: a SWOT analysis. Eur J Hum Genet 2016; 24:1651-1657. [PMID: 27577547 DOI: 10.1038/ejhg.2016.114] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 12/16/2022] Open
Abstract
Pharmacogenomics has been lauded as an important innovation in clinical medicine as a result of advances in genomic science. As one of the cornerstones in precision medicine, the vision to determine the right medication in the right dosage for the right treatment with the use of genetic information has not exactly materialised, and few genetic tests have been implemented as the standard of care in health systems worldwide. Here we review the findings from a SWOT analysis to examine the strengths, weaknesses, opportunities and threats around the role of pharmacogenetics in public health and clinical health care, at the micro, meso and macro levels corresponding to the perspectives of the individuals (scientists, patients and physicians), the health-care institutions and the health systems, respectively.
Collapse
Affiliation(s)
- Ritika Kapoor
- NUS Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore 117456, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Wei Chuen Tan-Koi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.,Vigilance and Compliance Branch, Health Products Regulation Group, Health Sciences Authority, Singapore Ministry of Health, Singapore 138667, Singapore
| | - Yik-Ying Teo
- NUS Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore 117456, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.,Life Sciences Institute, National University of Singapore, Singapore 117456, Singapore.,Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore 138672, Singapore.,Department of Statistics and Applied Probability, National University of Singapore, Singapore 117546, Singapore
| |
Collapse
|
4
|
Abstract
Atrial fibrillation (AF) is a major public health burden worldwide, and its prevalence is set to increase owing to widespread population ageing, especially in rapidly developing countries such as Brazil, China, India, and Indonesia. Despite the availability of epidemiological data on the prevalence of AF in North America and Western Europe, corresponding data are limited in Africa, Asia, and South America. Moreover, other observations suggest that the prevalence of AF might be underestimated-not only in low-income and middle-income countries, but also in their high-income counterparts. Future studies are required to provide precise estimations of the global AF burden, identify important risk factors in various regions worldwide, and take into consideration regional and ethnic variations in AF. Furthermore, in response to the increasing prevalence of AF, additional resources will need to be allocated globally for prevention and treatment of AF and its associated complications. In this Review, we discuss the available data on the global prevalence, risk factors, management, financial costs, and clinical burden of AF, and highlight the current worldwide inadequacy of its treatment.
Collapse
|
5
|
Pharmacogenomic diversity in Singaporean populations and Europeans. THE PHARMACOGENOMICS JOURNAL 2014; 14:555-63. [DOI: 10.1038/tpj.2014.22] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 03/28/2014] [Accepted: 04/15/2014] [Indexed: 02/07/2023]
|
6
|
Wong LP, Lai JKH, Saw WY, Ong RTH, Cheng AY, Pillai NE, Liu X, Xu W, Chen P, Foo JN, Tan LWL, Koo SH, Soong R, Wenk MR, Lim WY, Khor CC, Little P, Chia KS, Teo YY. Insights into the genetic structure and diversity of 38 South Asian Indians from deep whole-genome sequencing. PLoS Genet 2014; 10:e1004377. [PMID: 24832686 PMCID: PMC4022468 DOI: 10.1371/journal.pgen.1004377] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/28/2014] [Indexed: 12/18/2022] Open
Abstract
South Asia possesses a significant amount of genetic diversity due to considerable intergroup differences in culture and language. There have been numerous reports on the genetic structure of Asian Indians, although these have mostly relied on genotyping microarrays or targeted sequencing of the mitochondria and Y chromosomes. Asian Indians in Singapore are primarily descendants of immigrants from Dravidian-language–speaking states in south India, and 38 individuals from the general population underwent deep whole-genome sequencing with a target coverage of 30X as part of the Singapore Sequencing Indian Project (SSIP). The genetic structure and diversity of these samples were compared against samples from the Singapore Sequencing Malay Project and populations in Phase 1 of the 1,000 Genomes Project (1 KGP). SSIP samples exhibited greater intra-population genetic diversity and possessed higher heterozygous-to-homozygous genotype ratio than other Asian populations. When compared against a panel of well-defined Asian Indians, the genetic makeup of the SSIP samples was closely related to South Indians. However, even though the SSIP samples clustered distinctly from the Europeans in the global population structure analysis with autosomal SNPs, eight samples were assigned to mitochondrial haplogroups that were predominantly present in Europeans and possessed higher European admixture than the remaining samples. An analysis of the relative relatedness between SSIP with two archaic hominins (Denisovan, Neanderthal) identified higher ancient admixture in East Asian populations than in SSIP. The data resource for these samples is publicly available and is expected to serve as a valuable complement to the South Asian samples in Phase 3 of 1 KGP. Indians of South Asia has long been a population of interest to a wide audience, due to its unique diversity. We have deep-sequenced 38 individuals of Indian descent residing in Singapore (SSIP) in an effort to illustrate their diversity from a whole-genome standpoint. Indeed, among Asians in our population panel, SSIP was most diverse, followed by the Malays in Singapore (SSMP). Their diversity is further observed in the population's chromosome Y haplogroup and mitochondria haplogroup profiles; individuals with European-dominant haplogroups had greater proportion of European admixture. Among variants (single nucleotide polymorphism and small insertions/deletions) discovered in SSIP, 21.69% were novel with respect to previous sequencing projects. In addition, some 14 loss-of-function variants (LOFs) were associated to cancer, Type II diabetes, and cholesterol levels. Finally, D statistic test with ancient hominids concurred that there was gene flow to East Asians compared to South Asians.
Collapse
Affiliation(s)
- Lai-Ping Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jason Kuan-Han Lai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Woei-Yuh Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Rick Twee-Hee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Anthony Youzhi Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Xuanyao Liu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- NUS Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore
| | - Wenting Xu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Peng Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jia-Nee Foo
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Linda Wei-Lin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Seok-Hwee Koo
- Pharmacogenetics Laboratory, National University of Singapore, Singapore
| | - Richie Soong
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Markus Rene Wenk
- Department of Biochemistry, National University of Singapore, Singapore
- Department of Biological Sciences, National University of Singapore, Singapore
| | - Wei-Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chiea-Chuen Khor
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
| | - Peter Little
- Life Sciences Institute, National University of Singapore, Singapore
| | - Kee-Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yik-Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- NUS Graduate School for Integrative Science and Engineering, National University of Singapore, Singapore
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore
- Life Sciences Institute, National University of Singapore, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore
- * E-mail:
| |
Collapse
|
7
|
|