Precision Pharmacotherapy: Pharmacogenomics, Biomarkers and Omics Technologies: Identification of Drugs and Doses in Complex Diseases in Patients

Precision Pharmacotherapy:

Abstract

The trends of a booming rate of therapeutic failure and drug reactions in the management of complex diseases, are causing the current clinical paradigm of the one-size-fits-all pharmacotherapy quickly going out of business. Precision pharmacotherapy is intended to replace this type of empiricism with a solution that uses medical therapy based on the biological profile of each patient. This literature review involves a thorough critical review of how pharmacogenomics, multi-omics integration, and artificial intelligence came together to redefine the selection of drugs and dose optimization. We review the move to genomic profiling in general rather than single gene testing and ascertain the clinical utility of germline variants in drug metabolizing enzymes and transporters. Besides, the recent contribution of transcriptomics and proteomics to the unravelling of the non-genetic factors of drug resistance are discussed, particularly in the area of oncology and immunology. The use of companion diagnostics is investigated as a critical process of a biomarker-based therapy, which requires that targeted agents will be withheld from a patient with necessary molecular pathology. In addition, we assess the potential of artificial intelligence algorithms to be used for the  transformative interpretation of high-dimensional omics data to predict complex pharmacokinetic phenotypes. Lastly, the review discusses the high translational obstacles, in the fields of informatics, economics and ethics, to be overcome in order to allow the smooth assimilation of these technologies into the daily practice of clinical care. We conclude that multimodal precision-dosing framework is one of the essential requirements of the future sustainability of the healthcare system in the world.