PHARMACOGENOMICS
A game changer for personalisedmedicine?
Daniel Streetman PharmD, MS of Wolters Kluwer, Health, discusses the potential for pharmacogenomics to transform the efficacy of prescribed drugs and reduce instances of adverse drug reactions. He also explores the professional, ethical and logistical challenges that still need to be overcome for genomics to achieve widespread traction in the UK.
One of the toughest challenges facing clinicians on a daily basis is which drugs to prescribe to their patients, and at what dosage. While experience, expertise and access to the latest scientific information ensure that many of clinician/patient interactions end with a positive outcome, there are inevitably instances where treatment plans fail to achieve their objectives. This, understandably, can translate into patient frustration and, potentially, higher costs - as patients return to their healthcare provider again and again. Even more troubling are situations in which the drug and dosage appear correct, but trigger an unexpected side effect. In the US, for example, approximately 7000 deaths every year have been attributed to Adverse Drug Reactions (ADRs) – more than pulmonary disease, diabetes or pneumonia.1
Genetic-based decision making
There are various reasons why drug treatments might not work as anticipated, but one emerging field of enquiry that seeks to tackle this problem is pharmacogenomics – or the study of how an individual’s genetic profile can influence the effectiveness or side effect risk of a particular drug. Put simply, pharmacogenomics makes it possible to plug a patient’s genetic information into the treatment process so that clinicians are less reliant on a trial-and-error approach to prescribing medicines. During the first treatment assessment it quickly becomes possible to identify which drugs will prove ineffective for a certain patient – and whether
there are unique dosing or side effect implications. Across a wide range of clinical disciplines, pharmacogenomics is potentially a game-changer within the fast-moving field of personalised medicine.
Of course, anyone familiar with the field will know that the debate around the potential impact of pharmacogenomics has been rumbling on for a couple of decades. But the last few years have seen real momentum as more and more genetic variations that have a clinically important impact have become documented.
The UK, with the NHSsitting at the heart of its healthcare system, is well-placed to drive the global pharmacogenomics agenda as part of a wider shift towards personalised medicine.
AUGUST 2019
With detailed analysis of more than 150 drug-gene pairings available to clinicians, pharmacogenomics is no longer confined to labs and symposiums, but is having a real-world impact on patients. To cite one example, there is now comprehensive data to show how the presence or otherwise of enzyme cytochrome P450 2C19 impacts on an individual’s ability to metabolise many widely-used drugs, including the antiplatelet drug clopidogrel. Clearly, a person’s genetic ability to ‘turn on’ a drug like clopidogrel may have serious implications for patients with acute coronary syndrome.
Breaking down barriers There are still obstacles to
pharmacogenomics achieving universal adoption, but the good news is that progress is being made in dismantling them. For example, a key challenge in increasing the use of genomics-based information is that
WWW.CLINICALSERVICESJOURNAL.COM I 81
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92
