Table 3.
Summary of potential pharmacogenetic strategies to guide immunosuppressive drug prescribing
| Drug | Genotypes | Evidence | Ref |
|---|---|---|---|
| Tacrolimus | CYP3A5*1/*3 | Tested in a randomized controlled trial with earlier achievement of target blood concentrations but no influence on clinical outcome. | 58 |
| 59 | |||
| CYP3A4*22 | May provide additional predictive value to algorithms in combination with CYP3A5*1/*3. | 60 | |
| POR*28 | 61 | ||
| Sirolimus | CYP3A5*1/*3 | Impact on dose-normalized blood concentrations but not yet tested in a clinical trial. | 67–69 |
| Cyclosporin | CYP3A5*1/*3 | Combination of genotypes may predict drug exposure but not yet replicated. | 66 |
| CYP3A4*22 | |||
| Azathioprine | TPMT | Predicts individuals likely to develop severe myelotoxicity. Limited adoption in transplantation with no intervention study data. | 51 |
| Mycophenolate | UGT1A9 | Predicts individuals likely to be under-exposed to MPA with increased risk of rejection. | 71 |
| IMPDH1 | Predicts individuals at increased risk of rejection. Genetic component to variability in MPA exposure is much smaller than other factors, limiting the potential of pharmacogenetics. |
72 |
Abbreviations: IMPDH, inosine monophosphate dehydrogenase; MPA, mycophenolic acid.