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Banishing ‘One Size Fits All’ – Implementing Pharmacogenomics into the NHS

Written by Vered Smith, science writer 

A report has been published by the Royal College of Physicians and the British Pharmacological Society, exploring how to use pharmacogenomics within the NHS to improve patient outcomes.  

It explained the current clinical implementation of pharmacogenomics within the NHS, and explored strategies to make routine pharmacogenomic testing a reality in the near future. It also addressed education and training frameworks, legal issues, funding, and future research gaps. 

Pharmacogenomic Testing 

There are huge benefits to implementing pharmacogenomic tests as part of routine treatment. It greatly increases the probability that a person is treated effectively, and at the right dosage, the first time they take a drug. The paragon of success is Abacavir, a drug for HIV. 5-7% of patients who received this drug in the past suffered from abacavir hypersensitivity syndrome (AHS). This reaction has now been associated with a specific allele (HLA-B*57:01), and this allele is tested for before the patient is given the drug, eliminating AHS.  

The report contains examples of other drugs that currently use pharmacogenomic testing, such as clopidogrel, codeine, aminoglycoside antibiotics, fluoropyrimidines. It notes that we now have the technology to increase testing to include 40 of the 100 most commonly prescribed drugs. Although high costs of testing prevented routine pharmacogenomics in the past, the average test would currently cost about £100. 

However, frequent pharmacogenomic testing on a daily basis is hindered by other factors. These include a lack of healthcare professional training in pharmacogenomic advances, limited availability of tests, a lack of pharmacogenomic information in the electronic systems used by healthcare professionals, and the need for more research. 

Strategies to Make It a Reality 

The report offers recommendations and strategies to overcome these issues, including: 

  • Implementing pharmacogenomics in primary and secondary care settings, as well as at specialised centres.  
  • Mainstreaming pharmacogenomic services in the NHS through central funding, rather than locally-driven funding. This should avoid different levels of pharmacogenomic implementation based on location, and consequently avoid exacerbating inequalities.  
  • Ensuring the pharmacogenomic services are flexible enough to incorporate new gene-drug pairs, and constantly update the NHS National Genomic Test Directory based on new evidence. 
  • Implementing new services should occur alongside training and education of all healthcare sectors. 
  • Communicating and engaging with patient representative bodies, the public and the media. 
  • Providing funding for pharmacogenomic research. This also applies to research on the uptake, acceptance, equity of access, ethical issues, and legal issues of pharmacogenomics.  

The future of pharmacogenomics is exciting, as it holds the potential to help keep people healthier for longer. As Lord David Prior, Chair of NHS England, wrote in the report’s foreword, pharmacogenomics, “can now help us deliver a new, modern personalised healthcare system fit for 2022”. 

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