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Regine Kollek

Publications and source records attributed to Regine Kollek.

7 recordsLinked to original sources
PubMed2006

Pharmacogenetics, adverse drug reactions and public health.

Adverse drug reactions (ADRs) are a major public health problem. Pharmacogenetic testing prior to drug treatment is supposed to considerably alleviate this problem. The state of pharmacogenetic development was assessed by a systematic literature review, supplemented by expert interviews. Analysis of three case examples revealed that - with the exception of thiopurine methyltransferase (TPMT) - studies are lacking which unambiguously prove the clinical value of pharmacogenetic testing. Testing can prevent some, but by far not all ADRs. Since it does not compensate for clinical monitoring, pharmacogenetics can be regarded as add-on technology, applied in addition to established methods. A non-representative, explorative survey conducted amongst members of the German Society of Laboratory Medicine revealed that the demand for testing is limited and has not increased much, although a certain increase is expected in the future.

Adrenergic beta-Antagonists↗
PubMed2003

Individualized pharmacogenetic therapy: a critical analysis.

OBJECTIVE: Individualized, or personalized, therapy is highlighted as the declared goal of pharmacogenetics. In this paper, the content and significance of the individualization concept are analyzed. METHOD: Our analysis is based on a systematic reading of the current literature pertinent to pharmacogenetics. RESULTS: This analysis reveals that the pharmacogenetic understanding of individualization is based on a biomechanistic paradigm. In contrast to a notion of individualized therapy based on a biopsychosocial paradigm, this biomechanistic concept does not provide for individualization in psychosocial terms, but instead leads to the stratification and classification of patient populations. This finding does not necessarily cast doubt on the efficacy of pharmacogenetics, but does call its underlying ideology into question. CONCLUSION: The term 'individualization of therapy' does not reflect the real potential of pharmacogenetics, but instead represents a widely used and theoretically unjustified publicity slogan.

Humans↗
PubMed2003

Prospects and limits of pharmacogenetics: the thiopurine methyl transferase (TPMT) experience.

Thiopurine drug metabolism is a quintessential case of pharmacogenetics. A wealth of experimental and clinical data on polymorphisms in the thiopurine metabolizing enzyme thiopurine methyl transferase (TPMT) has been generated in the past decade. Pharmacogenetic testing prior to thiopurine treatment is already being practiced to some extent in the clinical context, and it is likely that it will be among the first pharmacogenetic tests applied on a regular basis. We analyzed the published TPMT data and identified some lessons to be learned for the future implementation of pharmacogenetics for thiopurines as well as in other fields. These include the need for comprehensive and unbiased data on allele frequencies relevant to a broad range of populations worldwide. The nature and frequency of TPMT gene polymorphisms in some ethnic groups is still a matter of speculation, as the vast majority of studies on TPMT allele distribution are limited to only a small subset of alleles and populations. Secondly, an appreciation of the limits of pharmacogenetics is warranted, as pharmacogenetic testing can help in avoiding some, but by far not all adverse effects of drug therapy. An analysis of six clinical studies correlating adverse thiopurine effects and TPMT genotype revealed that an average of 78% of adverse drug reactions were not associated with TPMT polymorphisms. Pharmacogenetic testing will thus not eliminate the need for careful clinical monitoring of adverse drug reactions. Finally, a careful approach toward dose increases for patients with high enzyme activity is necessary, as TPMT-mediated methylation of thiopurines generates a possibly hepatotoxic byproduct.

Animals↗
PubMed2003

[Evaluation of genetic screening. The problem of hidden value judgements, conceptual arbitrary attitudes and methodological leeway in the so-called screening process].

Population-wide genetic screenings can multiply benefits, but may also increase risks and other adverse effects of genetic testing. Insofar, there is a particular need for legitimization of genetic screenings. Health economic calculus and the so-called "screening ratios" aim to relate information about potential costs to potential benefits. Their implicit claim of being rational, however, can only be realised partially, since each concept is based on a number of value judgements allowing for different decisions, which can be a critical outcome factor. All the more so, since different players use different ratios. Against this background, disclosure of normative foundations and perspectives in cost-benefit ratios of genetic screenings seems to be imperative.

Genetic Testing↗