Pharmacogenetics: a general review on progress to date

BACKGROUND: Pharmacogenetics is not a new subject area but its relevance to drug prescribing has become clearer in recent years due to developments in gene cloning and DNA genotyping and sequencing. SOURCES OF DATA: There is a very extensive published literature concerned with a variety of different genes and drugs. AREAS OF AGREEMENT: There is general agreement that pharmacogenetic testing is essential for the safe use of drugs such as the thiopurines and abacavir. AREAS OF CONTROVERSY: Whether pharmacogenetic testing should be applied more widely including to the prescription of certain drugs such as warfarin and clopidogrel where the overall benefit is less clear remains controversial. GROWING POINTS: Personal genotype information is increasingly being made available directly to the consumer. This is likely to increase demand for personalized prescription and mean that prescribers need to take pharmacogenetic information into account. Projects such as 100 000 genomes are providing complete genome sequences that can form part of a patient medical record. This information will be of great value in personalized prescribing. AREAS TIMELY FOR DEVELOPING RESEARCH: Development of new drugs targeting particular genetic risk factors for disease. These could be prescribed to those with an at risk genotype.