Care Transformation Center Blog

How pharmacy is blazing the trail for precision medicine

by Samm Freedman

As we develop a better understanding of the genetic and molecular factors underpinning disease, pharmacogenomics can improve patient outcomes by reducing the use of ineffective medications and enhancing treatment response.

Pharmacogenomics is a critical component of precision medicine

Pharmacogenomics uses genetic testing to tailor the right drug and right dosage to an individual patient. More than 200 genes have been associated with the efficacy of a specific medication, shedding light on the genetic predispositions that influence health and disease. The advent of genetic testing enables a prescriber to forecast a patient's likelihood of responding to a specific medication and the risk of a patient experiencing an adverse drug event.

Medication ineffectiveness affects as many as 75% of cancer patients, 70% of Alzheimer’s patients, and 52% of osteoporosis patients. This inefficacy may result from a complex interplay of genetic and pharmacology factors, rendering the drug futile or even dangerous for certain patients. Codeine, for example, is converted into morphine in the body by a protein produced by the cytochrome P-450 2D6 gene. In the small population of patients who have a mutation in this gene, the body converts codeine too slowly, and the drug cannot relieve pain; in other individuals, a different mutation converts codeine too quickly, causing a dangerous accumulation of morphine in the body.

Pharmacogenomics is one of the keys to medication-quality improvements. For patients with major depression disorder (MDD), pharmacogenomics improves the treatment response rate by 70% and increases quality-adjusted life-years by 0.316 years. Moreover, improved clinical outcomes saved the health system $3,711 per patient in direct medical costs. Precision medicine can enhance clinical outcomes for the patient while reducing the costs of trial-and-error medicine.

Pharmacy is uniquely positioned to take the lead

Despite the importance of the relationship between genetics and medications, fewer than 10% of US hospitals have implemented pharmacogenomics programs. "Up until today we might ask the patient, 'Has somebody in your family had this problem before? What medications worked for them?' That really is a genetic question," said Mark Dunnenberger, PharmD, director of the pharmacogenomics program at NorthShore University HealthSystem in Evanston, IL.

The number of pharmacogenomics initiatives is expected to surge within the next five years, marking the rise of precision medicine that ensures prescriptions are as safe and effective as possible.

One example is the University of Florida Health Personalized Medicine Program. The initiative aims to tailor antiplatelet therapies for patients undergoing percutaneous coronary intervention (PCI) and stent placement. Fourteen pharmacists directly and indirectly worked to genotype more than 1,000 patients within the first year of the program. Pharmacist responsibilities ranged from the development of clinical decision support systems to patient and physician education. Due to their expertise in pharmacokinetics and medication efficacy, pharmacists were well-positioned to genotype patients and modify drug regimens accordingly.

 

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