Polypharmacy and precision medicine

Abstract

Precision medicine is an approach to maximise the effectiveness of disease treatment and prevention and minimise harm from medications by considering relevant demographic, clinical, genomic and environmental factors in making treatment decisions. Precision medicine is complex, even for decisions about single drugs for single diseases, as it requires expert consideration of multiple measurable factors that affect pharmacokinetics and pharmacodynamics, and many patient-specific variables. Given the increasing number of patients with multiple conditions and medications, there is a need to apply lessons learned from precision medicine in monotherapy and single disease management to optimise polypharmacy. However, precision medicine for optimisation of polypharmacy is particularly challenging because of the vast number of interacting factors that influence drug use and response. In this narrative review, we aim to provide and apply the latest research findings to achieve precision medicine in the context of polypharmacy. Specifically, this review aims to (1) summarise challenges in achieving precision medicine specific to polypharmacy; (2) synthesise the current approaches to precision medicine in polypharmacy; (3) provide a summary of the literature in the field of prediction of unknown drug–drug interactions (DDI) and (4) propose a novel approach to provide precision medicine for patients with polypharmacy. For our proposed model to be implemented in routine clinical practice, a comprehensive intervention bundle needs to be integrated into the electronic medical record using bioinformatic approaches on a wide range of data to predict the effects of polypharmacy regimens on an individual. In addition, clinicians need to be trained to interpret the results of data from sources including pharmacogenomic testing, DDI prediction and physiological-pharmacokinetic-pharmacodynamic modelling to inform their medication reviews. Future studies are needed to evaluate the efficacy of this model and to test generalisability so that it can be implemented at scale, aiming to improve outcomes in people with polypharmacy.

Binder jetting 3D printing in fabricating pharmaceutical solid products for precision medicine

“…1,2 For example, by monitoring patients' pharmacokinetic profile, the optimal dose and release profile can be determined, which can guide the design of a pharmaceutical product that controls the release of the drug molecule from the product to achieve the desired pharmacokinetic profile. [3][4][5] Technical product features can be also tailored, for example, if the person has swallowing difficulties, the pharmaceutical product can be designed in a way to avoid swallowing large objects, and orodispersible tablets or shape-optimized products would be of a choice. On the other hand, if the person cannot tolerate the taste of the product and does not have any issues with swallowing, the product would be designed in a way to avoid it dispersing in the mount.…”

“…Driven by new diagnostics and therapeutics, diversity in the patient population in terms of biological, genetic, clinical and environmental factors is considered in guiding the design and development of pharmaceutical products from the beginning of the formulation process to the manufacturing of the final products 1,2 . For example, by monitoring patients' pharmacokinetic profile, the optimal dose and release profile can be determined, which can guide the design of a pharmaceutical product that controls the release of the drug molecule from the product to achieve the desired pharmacokinetic profile 3–5 . Technical product features can be also tailored, for example, if the person has swallowing difficulties, the pharmaceutical product can be designed in a way to avoid swallowing large objects, and orodispersible tablets or shape‐optimized products would be of a choice.…”

Polypharmacy: Benefit or harm?

“…4 Þessi rannsókn og fleiri minna okkur á hversu flókið það er að þróa hugbúnað og samtengja klíníska þjónustu ásamt stafraenum verkferlum við persónumiðaða laeknisfraeði í aðstaeðum fjöllyfjameðferðar. 4,5 Vitundarvakning um lyfjaöryggi hefur opnað umraeðuna. Þörf er á aðgerðum til að baeta gaeði og öryggi fjöllyfjameðferðar ásamt upplýsingagjöf til einstaklinga.…”