Daniel Streetman, manager of referential content in the Metabolism, Interactions, & Genomics group with Clinical Effectiveness at Wolters Kluwer, discusses the potential for pharmacogenomics to transform prescribed drugs and reduce instances of adverse drug reactions.
Connected health
Prescribing the correct drug to a patient at the correct dosage is one of the most common daily challenges faced by clinicians, especially when the drug triggers an unexpected side effect.
There are a variety of reasons why drug treatments might not work as anticipated, including the patient’s genetic profile. This is why more work is now taking place to understand the complex relationship between the genome and drug response, in the fast-growing field of pharmacogenomics.
Pharmacogenomics allows clinicians to use a patient’s genetic information to guide both drug and dose selection, meaning they become less reliant on a trial-and-error approach to prescribing. During the treatment assessment it quickly becomes possible to identify drugs likely to prove ineffective for a certain patient and whether there are unique dosing or side effect implications. With this added insight, pharmacogenomics could potentially be a game-changer for personalised medicine, having an impact across a wide range of disciplines.
Gap in understanding
A key challenge in increasing the use of genomics-based information is that many clinicians, operating under extreme pressure, don’t understand it or haven’t had time to process it properly.
This is where clinical decision support tools like Lexicomp – a point-of-care drug information resource from Wolters Kluwer – has an important role to play in accelerating the use of pharmacogenomics, by making such data easier for clinicians to access.
Lexicomp has built genomics information into drug reference resources, with the aim of highlighting possibly important drug-gene pairings to clinicians in a clear, concise form, with actionable recommendations. The information should be readily available to any professional involved in drug administration, including hospital consultants, first responders, GPs and nurses as well as pharmacists.
Regulators are also encouraging the healthcare sector to embrace genomics. By providing guidance to drug companies on how to introduce biomarker information to their labelling, they have been helping legitimise the role of pharmacogenomics among the wider clinical community.
Key areas of impact
A major appeal of pharmacogenomics is that it has the potential to impact a wide range of clinical areas. Cardiology, psychology and oncology, for example, are all key areas of investigation. Some researchers also believe that an improved pharmacogenomics infrastructure could be the key to innovation in drug development for Alzheimer’s Disease, a condition that is projected to have a global cost to society of US$20.8 trillion between 2015-2050.
There is genuine optimism about the potential for pharmacogenomics to move into the mainstream over the next 5-10 years, especially as more patients’ genetic data becomes available. However, the growth of this new science could also bring challenges. One concern could be over-expectation about the possibilities of pharmacogenomics within the professional community and among patients. In a recent report into the ethics of pharmacogenetics, the Nuffield Council on Bioethics Report touched on the risk of over-promising when it said that genomics might not be about finding the “right drug for the right person,” but instead suggesting a potential drug preference for genetically defined groups.
NHS leading the way
Despite some of the concerns, the NHS is well-placed to drive the global pharmacogenomic agenda. The UK is already a pioneer in the field of genetic testing, with a history of sequencing genomes. The cutting-edge work into genomics by the NHS’ large teaching hospitals and the potential for knowledge and information-sharing between NHS Trusts could deliver these advances at scale and pace for patient benefit.
It will prove far harder for a genomic-based system to develop in countries where the healthcare system is fragmented and siloed and genetic data is less accessible.
The pace of change in genomics will be accelerated further by the new NHS Genomic Medicine Service, which should soon be operational, helping genomic screening and personalised treatments to become the norm. By 2025, it is predicted that half a million whole genomes should be sequenced through different NHS care pathways.
This scale of genomic data will be one of the key drivers to help turn pharmacogenomics from a promising new technology into a mainstream practice, leading to better and safe outcomes for patients.
About the author:
Dr. Daniel S. Streetman, PharmD, MS, is the manager of referential content in the Metabolism, Interactions, & Genomics group with Clinical Effectiveness at Wolters Kluwer Health. He completed a research fellowship in clinical pharmacology, with an emphasis in pharmacogenomics, at Bassett Healthcare in Cooperstown, NY, and was a clinical faculty member at the University of Michigan for several years prior to joining Wolters Kluwer. Dr. Streetman continues to maintain an academic relationship with several schools, lecturing on pharmacogenomics and other topics.