Actualités sur la pharmacogénétique

Abstract

the current state of clinical development of pharmacokinetics may seem rather disappointing in light of the hopes of some clinicians ten years ago and the considerable importance of the literature data. There seems to be no question that the evolution of technology is going to allow us to remove a number of barriers. It is now clear that the technology is there. Thus, we can already increasingly combine different genetic polymorphisms of different target genes (transport, metabolism, receptors, target enzyme, protein involved in signal transduction) in order to improve the predictive values of the tests. As a result of technical progress, DNA chips allowing the genotyping of several thousand polymorphisms will soon be available at ever lower costs. It is likely that these extensive genotyping will be possible from birth. This information will then be used over the course of life, and we can imagine that depending on the necessary treatment, prescription software and/or dosage adaptation will tell us that this drug is contra-indicated in this patient or that doses should be reduced by a certain factor or that biological monitoring should be strengthened in relation to a particular adverse event. Before we get to that point, when the technology is already in our laboratories, it remains to use “clinically relevant tests” for the benefit of the patient Current obstacles such as the lack of information from doctors on the value of genetic tests, on the way to prescribe these tests,the low development of these tests in routine laboratories and the lack of reimbursement of these tests (excluding nomenclature currently) can be dealt with quickly if there is a strong will on the part of health regulatory agencies or agencies to act quickly. Furthermore, in the coming years, it remains to define functional genetic polymorphisms in humans and to identify future clinically relevant «pharmacokinetics tests» to be reimbursed and promoted. This is the main objective of pharmacokinetics. Moreover, it seems indisputable and necessary to legislate on-line and public pooling of the results of pharmacokinetic studies on different populations carried out during development phases I and II, then IV, in order to increase and enrich the clinically relevant information already available. This will require greater collaboration between clinicians, pharmacokinetics and the pharmaceutical industry to better inform prescribers and patients. This seems necessary under penalty of exploding laboratories offering thousands of pharmacokinetics tests.