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Personalisierte Arzneitherapie auf genetischer Grundlage

Möglichkeiten und Beispiele aus der Praxis

Personalized drug therapy based on genetics

Possibilities and examples from clinical practice

  • Arzneimitteltherapie
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Zusammenfassung

Hintergrund

Die Pharmakogenetik ist ein wichtiger Baustein in der Individualisierung von Therapien. Eine pharmakogenetische Diagnostik findet jedoch bislang noch wenig Anwendung in der medizinischen Praxis. Eine konsequente Berücksichtigung individueller Patientenfaktoren in der Arzneimitteltherapie kann helfen, diese sicherer und effektiver zu gestalten.

Ziel der Übersicht

Es wird ein kurzer Überblick über Strukturen und Auswirkungen von genetischen Varianten auf Arzneimittelwirkungen gegeben. Einige häufig verordnete Medikamente werden exemplarisch herausgegriffen. Des Weiteren wird die Durchführbarkeit von pharmakogenetischer Diagnostik und Dosisanpassungen beschrieben.

Datenlage

Die European Medicines Agency (EMA) als europäische Zulassungsbehörde hat bereits über 70, die U.S. Food and Drug Administration (FDA) sogar über 150 Arzneimittelinformationen um Angaben zu Biomarkern erweitert. Dies ist ein entscheidender Schritt in Richtung gezielte Therapie. Internationale Leitlinien für die Dosis- und Therapieanpassung basieren auf einer systematischen Datenauswertung der klinischen Evidenz beispielsweise durch das Clinical Pharmacogenetics Implementation Consortium des Pharmacogenomics Research Network.

Schlussfolgerung

Wesentlich für den Erfolg einer Arzneimitteltherapie ist auch die Berücksichtigung individueller Risikofaktoren der Patienten. Eine pharmakogenetische Diagnostik muss von konkreten Dosierungs- und Therapieempfehlungen begleitet werden, um einen Beitrag zur Individualisierung und zur Verbesserung der Sicherheit und Effizienz der Arzneimitteltherapie leisten zu können.

Abstract

Background

Pharmacogenetics are an important component in the individualization of treatment; however, pharmacogenetic diagnostics have so far not been used to any great extent in clinical practice. A consistent consideration of individual patient factors, such as pharmacogenetics may help to improve drug therapy and increase individual safety and efficacy aspects.

Objective

A brief summary of structures and effects of genetic variations on drug efficacy is presented. Some frequently prescribed pharmaceuticals are specified. Furthermore, the feasibility of pharmacogenetic diagnostics and dose recommendations in the clinical practice are described.

Current data

The European Medicines Agency (EMA) as the European approval authority has already extended the drug labels of more than 70 pharmaceuticals by information on pharmacogenetic biomarkers and the U.S. Food and Drug Administration (FDA) more than 150. This is a crucial step towards targeted medicine. Guidelines on dose and therapy adjustments are provided by the Clinical Pharmacogenetics Implementation Consortium of the Pharmacogenomics Research Network.

Conclusion

It is fundamental to consider individual patient factors for successful drug therapy. Dose and therapy recommendations based on pharmacogenetic diagnostics are highly important for individualization as well as improvement of safety and efficiency of drug therapy.

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Authors and Affiliations

  1. Abteilung Forschung, Bundesinstitut für Arzneimittel und Medizinprodukte, Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Deutschland

    J. C. Stingl, K. S. Just, K. Kaumanns, M. Schurig-Urbaniak, C. Scholl & D. von Mallek

  2. Zentrum für Translationale Medizin, Medizinische Fakultät, Universität Bonn, Bonn, Deutschland

    J. C. Stingl, K. S. Just, K. Kaumanns, M. Schurig-Urbaniak, C. Scholl & D. von Mallek

  3. Institut für Klinische Pharmakologie, Universität Göttingen, Göttingen, Deutschland

    J. Brockmöller

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J.C. Stingl, K.S. Just, K. Kaumanns, M. Schurig-Urbaniak, C. Scholl, D. von Mallek und J. Brockmöller geben an, dass kein Interessenkonflikt besteht.

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Stingl, J.C., Just, K.S., Kaumanns, K. et al. Personalisierte Arzneitherapie auf genetischer Grundlage. Internist 57, 289–297 (2016). https://doi.org/10.1007/s00108-015-0013-7

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