UK should become first country in the world to offer £150 genomic testing so NHS patients can get ‘personalised prescriptions’
- Medics called on the NHS to enter a ‘new era’ of preventative medicine
- 99.5 per cent of people carry genetic quirks that mean some drugs do not work
- £150 tests taken once could tell pharmacists which medicines are likely to help
Britain should become the first country in the world to offer genetic tests that flag patients at risk of being prescribed drugs that don’t work or are harmful, according to a report.
The British Pharmacological Society and Royal College of Physicians have called for the NHS to enter a ‘new era’ of preventative medicine by offering the £150 tests.
The tests spot genetic quirks that prevent people from responding to certain drugs, such as codeine. It would allow patients to get ‘personalised prescriptions’.
Up to 90 per cent of drugs only work in as few as three in 10 people, while nearly 7 per cent of all hospital admissions in the UK are from reactions to medicines.
A ‘panel’ pharmacogenomic test — a group of gene tests which can be done at once using either saliva or blood — could be used to ensure certain drugs will work.
The tests are currently only offered on the NHS for specific HIV and cancer pills, but not for the most commonly prescribed drugs.
Private hospitals in the US have already started offering the DNA tests and a bill is in motion to routinely offer them to Americans.
The tests would only have to be done once in someone’s life — meaning pharmacists have results to hand when they prescribe — and could be introduced as quickly as in 2023, the report says.
Professor Sir Munir Pirmohamed, a pharmacologist at the University of Liverpool, said the NHS would ‘be the first integrated healthcare system in the world to implement’ pharmacogenomic tests which can tell if a certain type of drug will work on someone
Professor Sir Munir Pirmohamed, a pharmacologist at the University of Liverpool, said the NHS has the opportunity to become ‘the first integrated healthcare system in the world to implement this’.
Sir Munir, who co-authored the report, said: ‘What we are trying to do is improve the probability that a patient is going to respond to the first drug they are given and not use this [current] trial and error approach.
‘We are moving to a new era of medicine.’
Pharmacogenomics is a type of prescribing in which pharmacists are guided on what type of drug and dosage level to give based on a patients’ DNA.
Patients are given tests to work out if their genes mean some drugs do not work or would require different doses than normally given.
Although genomic testing is still a relatively new development in drug treatment, this field is rapidly expanding.
Currently, more than 200 drugs have label information regarding pharmacogenomic biomarkers — some measurable or identifiable genetic information that can be used to individualize the use of a drug.
Why is genomic information helpful?
Each gene provides the blueprint for the production of a certain protein in the body.
A particular protein may have an important role in drug treatment for one of several reasons, including the following:
- The protein plays a role in breaking down the drug.
- It helps with the absorption or transport of the drug.
- The protein is the target of the drug.
- It has some role in a series of molecular events triggered by the drug.
When researchers compare the genomes of people taking the same drug, they may discover that a set of people who share a certain genetic variation also share a common treatment response, such as:
- A greater risk of side effects
- The need for a higher dose to achieve a therapeutic effect
- No benefit from the treatment
- A greater or more likely benefit from the treatment
- The optimal duration of treatment
Source: Mayo Clinic
Speaking at a press briefing today, he added: ‘What we currently have is a national sickness service — we treat sick people.
‘What we need to do it move to a preventative National Health Service, which is what this would help with.’
Some 6.5 per cent of all hospital admissions are caused by adverse drug reactions, data shows.
One study has suggested that the cost of people being admitted to hospital for the problem is £2billion in England.
The team said there can be enormous variation between people over whether a medicine works, causes serious side effects and what dose is needed.
Two of the most common are codeine and chemotherapy drug 5-fluorouracil, with some genetic conditions meaning people either need different dosages or should avoid them entirely because they are harmful.
Scientists have established a genetic cause for such variation for 40 medicines.
For example, some people taking the common blood thinner clopidogrel lack the enzyme needed to convert its active substance and are therefore at higher risk of stroke.
Another example relates to the antibiotic gentamicin. About one person in every 500 carries a particular gene variant that predisposes them to hearing loss with this type of medicine.
Meanwhile, about 8 per cent of the UK population also lack the gene which allows codeine to work properly, meaning they will not get any pain relief.
Professor Sir Mark Caulfield, from Queen Mary University of London and president elect of the British Pharmacological Society, said: ‘I can tell you that 99.5 per cent of us in this room have at least one change in our genome that, if we come across the wrong medicine, it will either not work, or it will actually cause harm.
‘Some 25 per cent of us have four of these and it doesn’t matter what ancestry you are, everyone has these.’
Sir Mark said there was a need to ‘usher in an era of prevention’.
The tests will allow pharmacists to avoid having to try prescribing different medicines on patients and then tweaking the dosages or abandoning the course later, the group said.
In a foreword to the report, Lord Prior, chairman of NHS England, said: ‘Implementation of pharmacogenomics into the NHS would be the first example in the world of integration into a whole healthcare system, again highlighting the leadership of the UK in genomics.
‘I remember a time some five years ago when Professor Munir Pirmohamed came to see me to talk about the obscure, unknown and overlooked subject of pharmacogenomics, a subject of which I and most others knew little.
‘No longer. It is now mainstream, it is the future, it can now help us to deliver a new, modern personalised healthcare system fit for 2022, not 1948.’
Source: Read Full Article