The value of personalized approaches to improve pharmacotherapy in renal disease

PhD ceremony: Mr. S. Vegter, 14.30 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: The value of personalized approaches to improve pharmacotherapy in renal disease

Promotor(s): prof. M.J. Postma, prof. G. Navis

Faculty: Mathematics and Natural Sciences

Renal diseases decrease patients’ life expectancy and quality of life and strain health-care budgets. In the quest to improve pharmacotherapy, personalized approaches tailored for individual patients are increasing in importance. Work presented in the thesis of Stefan Vegter includes a checklist for health technology assessment of genetic screen-and-treat strategies; and explored two such strategies in renal medicine. It was found that the ACE (I/D) polymorphism influences the (cost-)effectiveness of ACE inhibitors in non-diabetic renal disease. The second genetic strategy involved a polymorphism coding for the CCR5 receptor, the genetic deficiency of which is associated with improved survival in dialysis patients. A modelling study in this study suggested that pharmacologic blockade of the CCR5 receptor has similar potential for clinical and economic benefits. Vegters thesis also deals with non-genetic approaches to improve pharmacotherapy. Firstly, optimal prescribing strategies may result in economic benefits, as studied in his thesis for specific phosphate binders (lanthanum carbonate) used as second-line therapy. Evidence was also presented favouring cheap RAAS intervening drugs, as no difference in therapy compliance was found between cheap and more expensive drugs. Secondly, pharmacotherapy can be improved by correctly diagnosing and treating adverse side effects, as studied in this thesis for ACE inhibitor induced cough. Thirdly, therapy effectiveness of ACE inhibitors can be improved for patients eating too much salt; lower salt intake was associated with decreased renal disease progression. In conclusion, personalized approaches to improve pharmacotherapy in renal disease may improve the individual patients’ health and quality of life, and may also decrease the economic disease burden for society.