Pharmacogenomic testing in paediatrics: clinical implementation strategies

Barker, Charlotte IS, Groeneweg, Gabriella, Maitland‐van der Zee, Anke H, Rieder, Michael J, Hawcutt, Daniel B ORCID: 0000-0002-8120-6507, Hubbard, Tim J, Swen, Jesse J and Carleton, Bruce C (2022) Pharmacogenomic testing in paediatrics: clinical implementation strategies. British Journal of Clinical Pharmacology, 88 (10). pp. 4297-4310.

Text BJCP_Paediatric_PGx_Imp_RV_FINAL Clean.docx - Author Accepted Manuscript Download (236kB)

Abstract

Pharmacogenomics (PGx) relates to the study of genetic factors determining variability in drug response. Implementing PGx testing in paediatric patients can enhance drug safety, helping to improve drug efficacy or reduce the risk of toxicity. Despite its clinical relevance, the implementation of PGx testing in paediatric practice to date has been variable and limited. As with most paediatric pharmacological studies, there are well-recognised barriers to obtaining high-quality PGx evidence, particularly when patient numbers may be small, and off-label or unlicensed prescribing remains widespread. Furthermore, trials enrolling small numbers of children can rarely, in isolation, provide sufficient PGx evidence to change clinical practice, so extrapolation from larger PGx studies in adult patients, where scientifically sound, is essential. This review paper discusses the relevance of PGx to paediatrics and considers implementation strategies from a child health perspective. Examples are provided from Canada, the Netherlands and the UK, with consideration of the different healthcare systems and their distinct approaches to implementation, followed by future recommendations based on these cumulative experiences. Improving the evidence base demonstrating the clinical utility and cost-effectiveness of paediatric PGx testing will be critical to drive implementation forwards. International, interdisciplinary collaborations will enhance paediatric data collation, interpretation and evidence curation, while also supporting dedicated paediatric PGx educational initiatives. PGx consortia and paediatric clinical research networks will continue to play a central role in the streamlined development of effective PGx implementation strategies to help optimise paediatric pharmacotherapy.

Item Type:	Article
Uncontrolled Keywords:	children, personalised medicine, pharmacogenetics, precision medicine
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	20 Dec 2021 08:09
Last Modified:	18 Jan 2023 21:18
DOI:	10.1111/bcp.15181
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3145667