Gene panel to guide antiseizure medication prescribing: Does the cost justify the benefits?

Abstract

Pharmacogenomics (also known as pharmacogenetics) is the study of how an individual's genetic variants influence drug responses, including the variants associated with adverse drug reactions and treatment efficacy. Genes encoding antiseizure medications (ASMs) metabolic enzymes, transporters, and carriers are important modulating factors of drug response, and account for interindividual differences in the efficacy and adverse reactions of ASMs. Pharmacogenomics hold the potential to identify variants associated with response to ASMs, and could therefore lead to personalized epilepsy treatment, with the promise of the right drug for the right patient. A previous study has identified 123 genes implicated in the metabolism, transport, and target pathways of six ASMs, including levetiracetam, sodium valproate, lamotrigine, carbamazepine, zonisamide, and perampanel. 1 However, the downstream effects of pharmacogenomics on decisions regarding personalized selection of ASMs and ultimately on patient outcomes are not fully understood. Microsimulation provides an opportunity to model the downstream effects