Pharmacogenomics of Rheumatic Diseases in Mexican Mestizo Populations: A Systematic Review of 291 Publications with Allele Frequency Meta-Analysis
We present a comprehensive review of 291 publications addressing pharmacogenomic variation relevant to rheumatic disease therapy in Mexican mestizo populations. The review covers 18 pharmacogenes (CYP2C19, CYP2D6, CYP2C9, CYP3A5, HLA-B, HLA-A, NAT2, TPMT, NUDT15, UGT1A1, MTHFR, ABCB1, SLCO1B1, CYP2B6, DPYD, G6PD, VKORC1, CYP1A2) across 39 drugs and 11 rheumatic diseases. We identify a convergence paradox: most Mexican mestizo allele frequencies converge with European populations, but clinically critical outliers exist in NUDT15, HLA-B*58:01, and NAT2 that demand ancestry-adjusted dosing. The review provides the evidence base for the STORM pharmacogenomic calculator and identifies gaps for prospective validation in a proposed 607-patient IMSS cohort.