Construction of pharmacogenomics-guided individualized medication list for elderly patients

LI Xinya; WU Jingjing; JI Liwei; ZHANG Qingxia; YANG Li; LI Hui; LIU Shuang; LI Ting; ZHAO Rongsheng; YI Zhanmiao

doi:10.6039/j.issn.1001-0408.2023.03.01

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Construction of pharmacogenomics-guided individualized medication list for elderly patients

更新时间：2023-02-22

- Construction of pharmacogenomics-guided individualized medication list for elderly patients
- ZHONGGUO YAOFANG Vol. 34, Issue 3, Pages: 257-262(2023)
- 作者机构：
  
  1.北京大学第三医院药剂科，北京　100191
  2.北京大学医学部药物评价中心，北京　100191
  3.北京大学药学院药事管理与临床药学系，北京　100191
  4.北京医院药学部/国家老年疾病临床医学研究中心，北京　100730
  5.首都医科大学宣武医院药学部/国家老年疾病临床医学研究中心，北京　100053
  6.首都医科大学附属北京天坛医院药学部，北京　100070
  7.上海交通大学医学院附属瑞金医院药剂科，上海　200025
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.03.01
  CLC： R979.9
- Published：15 February 2023，
  
  Received：22 August 2022，
  
  Revised：21 December 2022，
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李欣亚,吴晶晶,纪立伟等.药物基因组学指导的老年患者个体化用药目录构建 ^Δ[J].中国药房,2023,34(03):257-262.

LI Xinya,WU Jingjing,JI Liwei,et al.Construction of pharmacogenomics-guided individualized medication list for elderly patients[J].ZHONGGUO YAOFANG,2023,34(03):257-262.
李欣亚,吴晶晶,纪立伟等.药物基因组学指导的老年患者个体化用药目录构建 ^Δ[J].中国药房,2023,34(03):257-262. DOI： 10.6039/j.issn.1001-0408.2023.03.01.

LI Xinya,WU Jingjing,JI Liwei,et al.Construction of pharmacogenomics-guided individualized medication list for elderly patients[J].ZHONGGUO YAOFANG,2023,34(03):257-262. DOI： 10.6039/j.issn.1001-0408.2023.03.01.

摘要

目的

基于循证药学方法制定老年患者个体化用药目录，以助力临床合理用药决策。

方法

首先，充分利用循证药学信息，筛选出有风险基因信息的药物；其次，统计药物在不同数据来源的收录情况，选取3个及以上数据来源收录的药物，结合项目组专家委员会讨论确定的药物，纳入目录；再次，选取2个数据来源收录的药物，设计问卷对药物相关基因检测的必要性展开调查，根据专家问卷调查的评分结果，按得分高低纳入药物。数据来源包括真实世界数据（医院高频用药清单、老年患者门诊和住院医保高频用药清单、用药差错高频药物清单等）和循证药学证据（临床药物基因组学实施联盟、荷兰药物遗传学工作组、美国食品药品监督管理局网站等）。

结果

本研究首先获得3个数据来源收录并有风险基因信息的药物68种，结合项目组专家委员会讨论确定的23种药物，去重后形成74种药物清单。其次，对于2个数据来源收录并有风险基因信息的37种药物，研究通过专家问卷调查形成26种药物清单，最终形成包含100种药物的老年患者个体化用药目录。目录中包括中枢神经系统药物43种、心血管系统药物15种、抗肿瘤药12种等。有12种药物被6个及以上数据来源收录，其中消化系统药物最多，均为质子泵抑制剂。

结论

本研究通过循证药学方法遴选出100种需个体化给药的老年患者常用药物。目录将随着证据的变化更新，可为老年患者合理用药提供指导。

Abstract

OBJECTIVE

To develop an individualized medication list for elderly patients by evidence-based pharmacy method， and to support clinical decisions on rational use of medicines.

METHODS

Firstly， drugs with risk genetic information were screened out by systematically reviewing evidence-based pharmacy information. Secondly， researchers investigated the included drugs in lists from different data sources. Drugs included in three or more data sources and drugs proposed by the expert committee were then included in the medication list. Thirdly， for the drugs included in two data sources， researchers designed questionnaires to investigate the necessity of drug-related gene testing. According to the scoring results of the expert questionnaire， drugs with higher scores were included in the list. Data sources included real-world data （list of high frequency medication in hospitals， high frequency medication for elderly outpatients and inpatients in National Health Care Claims Data， drugs related to frequent medication errors and so on） and evidence-based pharmacy evidence （the websites of Clinical Pharmacogenomics Implementation Consortium， Dutch Pharmacogenetics Working Group， Food and Drug Administration and so on）.

RESULTS

The study obtain 68 drugs with risk genetic information which were included in three data sources. Combined with 23 drugs proposed by the expert committee， a list containing 74 drugs was preliminarily formed after de-duplication. A total of 37 drugs included in two databases with risk genetic information were scored through the questionnaire survey to form a supplementary list of 26 drugs. This is the final composition of the list of 100 drugs developed in this study. Among them， there are 43 drugs for the central nervous system， 15 drugs for the cardiovascular system， 12 anti-tumor drugs and so on. Twelve drugs were included in six or more data sources， which mainly consisted of drugs for digestive system， all proton pump inhibitors.

CONCLUSION

In this study， a list of 100 commonly used drugs which require individualized medication for the elderly was developed by evidence-based pharmacy method. The drug list will be updated in time as available evidence changes， and can provide guidance for rational use of medicines for elderly patients.

关键词

老年患者个体化药物基因组学药物目录循证药学

Keywords

individualizationpharmacogenomicsmedication listevidence-based pharmacy

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