Health leaders across the UK have highlighted the importance of pharmacogenomics education for the pharmacist workforce, as well as the need to make genomics data easily accessible to clinicians for use in their decision making.
At the 10th annual open meeting of the UK Pharmacogenetics and Stratified Medicine Network, Vicky Chaplin, pharmacy genomics lead at NHS England, Professor Sandosh Padmanabhan, Professor of cardiovascular genomics and therapeutics at University of Glasgow, Sian Morgan, head of the All Wales Genetics Laboratory, and Professor Ian Young, chief scientific advisor to the Department of Health in Northern Ireland, spoke about pharmacogenomics implementation across the four UK nations.
Pharmacogenomics uses information from a patient’s DNA to understand how their body might respond to medicines. It could be used to develop personalised medicines, such as adjusting a patient’s dosage based on how fast they metabolise a drug, or finding the right therapeutic treatment in the first instance, rather than using trial and error.
Currently, pharmacogenomic testing is being piloted in four GP surgeries and primary care networks (PCNs) in the North West of England, as part of the PROGRESS research project run by the NHS North West Genomic Medicine Service (GMS) Alliance.
It is testing how a patients’ genetics interact with medicines including antidepressants (SSRIs and tricyclic antidepressants), statins, and proton pump inhibitors.
Practice staff – including pharmacists, GPs and other healthcare professionals – are supported by a genomic prescribing advisory system, and the pilot will help inform discussions on the utility, outcomes and cost effectiveness of the pharmacogenomics approach.
But Professor Sandosh Padmanabhan, who was speaking about the implementation of pharmacogenomics in Scotland, told delegates that many clinicians had concerns about their own expertise in the area.
‘The biggest worry from GPs and secondary care doctors is: “Is it going to increase my workload? I don't know genetics”,’ he said.
He said that there was ‘no off the shelf solution for pharmacogenomics that could be implemented into the NHS’, and so the NHS was looking to partner with a provider through the innovation pathway for NHS products, which would see a provider co-developing a solution that would be implementable by the NHS, in return for a guaranteed contract once the product had been developed satisfactorily.
But he said that progress on this was currently slow as there were many complex needs that would likely need to be met by a collaboration of providers.
However, he said that the Scottish Government was keen to fast track innovation like pharmacogenomics, and gave the example of one organisation – NHS Tayside – that had found through a small study that using genotyping within its stroke clinic to test the effectiveness of clopidogrel delivered better patient outcomes and cost savings.
‘Health economics is critical – that has to be at the centre of delivery strategy,’ he said. He added that while it might take a long time to get good evidence of the costs savings that pharmacogenomics could bring, it was important to demonstrate cost savings to encourage adoption of genomic medicine.
He said that a next step for the service in Scotland would be to increase collaboration with and learn from the other nations, as well as embedding pharmacogenomics education into training for pharmacists and nurses.
Sian Morgan, deputy chair of the national pharmacogenetics group in Wales said that political awareness and a clear strategy were ‘really, really key’ to driving any change within the healthcare system, including in the area of pharmacogenomics.
In addition to the Genome UK Future of Healthcare paper, The Genomics Delivery Plan for Wales sets out the direction of pharmacogenomics implementation in Wales, as well as the 2017 Genomics for Precision Medicine in Wales strategy.
These publications gave a clear direction on the future of pharmacogenomics in Wales, including ‘the realisation that there was a real requirement for pharmacogenomic testing in the near future’, and a particular focus on reducing the burden of adverse drug reactions (ADR), she said.
Ms Morgan also drew attention to the need to upskill the workforce in pharmacogenomics, highlighting the part-time, flexible pharmacogenomics e-learning module developed by Bangor University, as well as the recent appointment of Sophie Harding, formerly the pharmacogenomics lead at the Royal Pharmaceutical Society (RPS), as the clinical lead for pharmacogenomics at Health Education and Improvement Wales (HEIW).
She also said that how much information was sequenced and shared with clinicians and patients was an decision that would be made at a UK-wide level.
‘You might sequence or you might test a lot but you might only want to share certain amounts of information within certain clinical scenarios,’ she said, adding that in addition to the reports generated by genomic testing laboratories, ‘the most critical part of the pathway’ would be the decision support tools for clinicians.
Professor Ian Young, clinical professor at Queen’s University Belfast and chief scientific advisor to the Department of Health in Northern Ireland, also spoke about the importance of the availability and accessibility of pharmacogenomics data.
He said that his long-term hope for pharmacogenomics would be that rather than a patient having several tests related to specific medicines reactions, they could just have their genome sequenced once and then that information would be available to clinicians with a specific query.
‘I think our longer term ambition is that we land in a position not where there's a question about what pharmacogenetic tests actually do, but the question should be, what pharmacogenomics question am I asking, and that [data] will already exist in the record, and will be available, accessible and will come with appropriate interpretation so that clinician can utilise the data in relation to the question that they are seeking to ask,’ he said.
And he said that ultimately AI could be used to assist clinicians with interpreting the pharmacogenomics test results, which they could use to inform their decision making.
He added: ‘That is a longer term aspiration and position. And clearly there's a journey between where we are now and where we should be then, and there are a number of intermediate stages which are likely to be important.’
And he said that pharmacogenomics information ‘needs to be available in a way that clinicians think help them and ease their workflow, rather than seeing this as an additional job, which will take more of their time and responsibility’.
And he said that while ‘health is devolved’, there was ‘no doubt that there's an expectation at a population level that people will have access to similar quality and range of services’ as patients in the rest of the UK, as well as in the Republic of Ireland.
He also said that challenges remained in the sphere of pharmacogenomics, such as cost effectives as well as the need to build an evidence base across different ethic groups.