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New UK Report: Embracing Pharmacogenomics Can Revolutionize Medicine

A groundbreaking report released by the British Pharmacological Society and the Royal College of Physicians says that matching drugs to DNA can kickstart a new era of medicine.

The report, “Personalized Prescribing: Using Pharmacogenomics to Improve Patient Outcomes”, was released March 24, 2022, and has the backing of the leading UK healthcare organizations.

“We need to move away from the paradigm of ‘one drug and one dose fits all’ to a more personalized approach where patients are given the right drug at the right dose to improve the effectiveness and safety of medicines,” said Professor Sir Munir Pirmohamed, David Weatherall Chair of Medicine at the University of Liverpool and chair of the report’s working party.

Pharmacogenomics: How Genes Affect Our Response to Drugs

At the core of the report is the field of pharmacogenomics (sometimes called pharmacogenetics) which studies how a person’s genes affect how he or she responds to medications.

The report says that pharmacogenomic testing (PGx) should be deployed across the NHS to ensure all patients have an equal chance of being prescribed a medicine at a dose that is likely to be safe and effective for them, with minimal side effects.

“In simple terms, our understanding of human biology has been transformed by the sequencing of the human genome and our new-found knowledge of genetic variation. We have always known that we were different, now we know why. And we can use that knowledge to predict illness, diagnose illness and to treat illness on an individual, personalized basis,” writes Lord David Prior, chair of the NHS England, in the forward to the report. “This will revolutionize medicine, and combined with a digitally driven population health approach, fundamentally change the traditional model of care.”

Pharmacogenomic testing, says the Royal College of Physicians, can be used to discover which variants of genes an individual carries, and whether they impact on the response to medicines they are given. This information can be used to guide the choice of medicine and dose, increasing the likelihood that each person receives the most effective medicine for them, at the best dose, the first time they are treated.

Genetic Testing Available for Nearly Half of Most Prescribed Medicines

The Royal College of Physicians says that there is enormous variation from person to person in whether a medicine works, whether it causes serious side effects and what dose is needed.

Fortunately, researchers have already found genetic causes for variations for over 40 of the leading 100 medicines currently prescribed.

Some pharmacogenomic tests are already available in the UK:

  • A drug called abacavir used to treat HIV
  • A drug called 5-fluorouracil used to treat certain cancers.

In the past, according to the BBC report, 5 to7 percent of people would have a bad reaction to abacavir and some died. Testing people's DNA before prescribing the drug means the risk is now zero.

However, tests are not available for some commonly prescribed painkillers, beta blockers and antidepressants such as:

  • An antibiotic called gentamicin that is used intravenously to treat serious infections. Around one person in every 500 carries a particular gene variant that predisposes them to hearing loss with this type of medicine.
  • Another example is codeine, a very widely used painkiller. About eight percent of the UK population lack the gene which allows this medicine to work properly, meaning they will not get any pain relief.

“Scientists have learned a great deal about how inherited differences in your genes can affect your body’s response to medications. Pharmacogenomic testing can be used to discover which variants of genes you carry, and how they are likely to influence the way your body responds to medicines you might be given,” said the report summary.

One Genetic Test Can Help with a Lifetime of Decisions

The report’s summary for patients and the public points out that one genetic test can help with a lifetime of medical decisions.

“Because your genes hardly change throughout your lifetime, a pharmacogenomic blood test needs to be done once. The test results could then be used throughout your life to guide the choice and the dose of medicine, making it more likely that you receive the most effective medicine for you the first time you are treated, and with the fewest potential side effects,” says the report.

A commentary on the report, which will be published in the British Journal of Clinical Pharmacology, explains that almost 99 percent of people carry at least one of these genetic variations.

“Patients must be at heart of this. We need to create an understanding of pharmacogenomic testing, how it works, and the health benefits it offers,” said report co-author Dr. Emma Magavern, a clinician at Queen Mary University in London.

The BBC says that the report’s vision is “to perform the test when one of the 40 drugs is prescribed. In the long term, the ambition is to test well ahead of time - possibly at birth if genetic testing of newborns goes ahead, or as part of a routine check-up in your 50s.”

The reality is that an aging population will require more and more medication.

“People are living longer today than ever before. But an aging population means more and more of us are likely to live with long-term health conditions that require medication. This means the number of medicines we are taking is increasing,” says the report’s summary. “The ultimate goal is to make pharmacogenomic-based prescribing a reality for all in the UK NHS. This will empower healthcare professionals to deliver better, more personalized care, and in turn improve outcomes for patients and reduce costs to the NHS.”

Lord Prior said that five years ago, pharmacogenomics seemed like an obscure, unknown and overlooked subject but that is no longer the case in 2022.

“It is now mainstream, it is the future, it can help us to deliver a new modern personalized healthcare system fit for 2022, not 1948,” said Lord Prior.

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