Pharmacogenomic diversity among Arab populations: A systematic review

Pharmacogenomics enables precision pharmacotherapy by linking genetic variation to drug response, yet Arab populations are underrepresented in global reference datasets. We systematically synthesized pharmacogenomic allele-frequency evidence across Arab countries, focusing on clinically actionable genes, to describe population variation, identify high-priority variants, and highlight research gaps. We analyzed 295 studies including 94,346 individuals from 19 countries, pooled country-level allele counts for frequently tested variants, and compared pooled estimates with Middle Eastern reference frequencies. Across most loci, allele-frequency profiles were broadly similar between countries, but several variants showed marked, locus-specific differences with direct relevance to anticoagulants, statins, thiopurines, antidepressants, and fluoropyrimidines. Evidence was uneven across countries and often limited by inconsistent genotyping and incomplete reporting of haplotypes and structural variation. These findings support variant-focused implementation, underscore the need for better population coverage and standardized reporting, and motivate development of a regional pharmacogenomics resource to improve the safety and effectiveness of therapy.