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The potential role of PGx in managing experimental therapies for COVID-19

Since the outbreak of the COVID-19 pandemic, many clinical trials have been launched to help understand the virus and any treatment options, but while this is ongoing, clinicians are having to make treatment decisions for critically ill patients with limited information on the safety and efficacy of the options.

Recent news articles have shown that genomic scientists are leading the fight against COVID-19, but now people are starting to turn towards pharmacogenetics for answers in treatment decisions.

As some of the drugs being trialled for COVID-19 are associated with arrhythmia and sudden death, PGx could help to identify patients who are genetically predisposed to adverse drug reactions. Having this information to hand could help clinicians avoid additional risks for some patients. For example, the FDA granted emergency use of hydroxychloroquine to treat certain adults and adolescents over 50kg who are hospitalised with COVID-19 and cannot take part in a clinical trial. However, this drug is known to cause arrhythmias in patients with existing cardiovascular disease – a high-risk group for COVID-19. Hydroxychloroquine is known to have drug-gene interactions and using PGx could avoid serious complications and in some cases, death.

Howard McLeod, a pharmacogenetics expert from the Moffitt Cancer Center, noted that there is nowhere for the general public to input the drugs they are on and educate themselves about possible interactions they may be at risk for. This information would be vital if they became infected with the virus and had to undergo experimental therapy.

Despite hydroxychloroquine having potential life-threatening side effects, pharmacies in the US have seen an increase in prescriptions for the drug, regardless of the lack of supporting evidence for its efficacy in COVID-19 cases. This prompted McLeod to encourage Pharmazam to develop an app to flag potential drug/gene, drug/drug, or allergic reactions a person might have and make it available to the public. The app is free to download but PGx testing is not free.

However, some of the treatment options being explored do not have any evidence of drug/gene interactions, indicating that PGx might be a missing piece in helping combat the crisis.