Volume 5 • Issue 1 • 1000134 J Biomol Res Ther ISSN: 2167-7956 JBMRT, an open access journal Open Access Research Article Bhinder et al., J Biomol Res Ther 2015, 5:1 DOI: 10.4172/2167-7956.1000134 Keywords: Methotrexate; Pharmacogenetic testing; Leukemia Introduction Te ideal target of pharmacotherapy is to have optimal clinical outcomes, characterized by the complete treatment of a health illness with minimal adverse efects. As of today, is this possible? Until recently, health care providers had no idea why certain patients have a positive response to a drug therapy while others experience side efects from same therapy. It is known that patients can achieve better results when receiving individualized treatment, possibly because individualized medicine requires that one seeks a deep understanding on how medicine is metabolized by an individual’s body. Although clinical practice experience indicates that to be mostly true, how can we assure the best health care of tomorrow? A form of providing individualized care is called pharmacogenomics or pharmacogenetics. As described by the FDA, “pharmacogenomics allows one to identify sources of an individual’s profle of drug response and predict the best possible treatment option for this individual. Te use of genomic information has opened new possibilities in drug discovery and development.” Te FDA provides a table of pharmacogenomics biomarkers in drug label, in order to identify responders and non- responders to medications, avoid adverse events, and optimize drug dose. Drug label may contain information on genomic biomarkers and can describe: drug exposure and clinical response variability, risk for adverse events, genotype specifc dosing, mechanisms of drug action, and polymorphic drug target and disposition genes. For example, due to the fact that medications like codeine do not properly work for some individuals, specifcally those considered ultra-rapid metabolizers for CYP2D6; the FDA has issued boxed warnings with use for this specifc population, including counseling information [1]. Tere are many studies proposing that, by selecting treatment based on a patient’s specifc genes via pharmacogenetic testing, we can predict the probability of success or failure of a particular pharmacotherapy. Based on individual specifc genetic diferences, pharmacogenetics can explain existing variability in drug response from its metabolism to adverse reactions. Methotrexate is commonly used as a chemotherapeutic agent for childhood acute lymphoblastic leukemia (ALL), amongst other diseases. However, treatment is limited due to severe toxicity or low efcacy of treatment for certain patients. Methotrexate has been shown to exhibit diferent responses based on the genetic expressions and variations of the genes SLC19A, SHMT, ABCB1, ATIC and MTHFR. For this literature evaluation, we examined the clinical relevance of pharmacogenetics testing for leukemia patients treated with Methotrexate. Furthermore, the treatment outcome for *Corresponding author: Mohammad S Shawaqfeh, Pharm D, Ph.D, Nova Southeastern University, Palm Beach Gardens, FL, United States, Tel: 561-805- 2243; E-mail: mshawaqfeh@nova.edu Received February 28, 2015; Accepted December 15, 2015; Published December 26, 2015 Citation: Bhinder MTM, Halum AS, Mufih SM, Shawaqfeh M (2015) Pharmacogenetic Testing for Methotrexate Treatment in Leukemia Patients. J Biomol Res Ther 4: 134. doi:10.4172/2167-7956.1000134 Copyright: © 2015 Bhinder MTM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: Pharmacogenetic testing can be used as a means to individualize a patient’s medical regimen in order to prevent future adverse drug events. Pharmacogenomics looks at individual genes and can predetermine a patient’s susceptibility to certain side effects of medications, as well as how effcacious a medication will be for that patient. Methotrexate has been shown to exhibit different responses based on the genetic expressions and variations of the genes SLC19A, SHMT, ABCB1, ATIC and MTHFR. Objective: To determine the clinical relevance of pharamcogenetic testing for leukaemia patients treated with Methotrexate. Method: A systematic review was conducted from September 2013-August 2015, primarily using the EMBASE and PubMed databases, identifying Cochrane reviews, controlled clinical trials, randomized control trials, meta-analyses and systematic reviews. Search terms that were initially included were the name of the genes individually (SLC19A, SHMT, ABCB1, ATIC and MTHFR), methotrexate, and leukemia. The results were further limited to English and those conducted on humans. Two reviewers extracted data and evaluated pertinent studies. A total of 82 articles were found, but were then narrowed down to 34 articles. The 34 articles were graded with the JADAD scale, with scores ranging from of 0-5 points. They were then evaluated for clinical relevance, and were reduced to 10 articles to be analysed for the purpose of the study. Results: Of the 34 article graded, 26 articles had a score of 0 points. Conclusion: Although there is signifcant evidence of an association between the clinical effects of methotrexate in leukemia patients and these genes, based on their JADAD scores, there appears to be a lack of high evidence clinical studies. None of the article found included randomized controlled trials, despite compelling evidence indicating a need for these high quality studies in order to administer methotrexate to patients in a safer manner. Pharmacogenetic Testing for Methotrexate Treatment in Leukemia Patients Muhammad Tahir M Bhinder, Amin Saleh Halum, Suhaib M Mufih and Mohammad Shawaqfeh 1 * College of Pharmacy, Nova Southeastern University, FL, USA Journal of Biomolecular Research & Therapeutics J o u r n a l o f B i o m o l e c u l a r R e s e a r c h & T h e r a p e u t i c s ISSN: 2167-7956