A call for increased use of pharamacogenomic data in the clinic

In a recent review article published in the New England Journal of Medicine, authors Liewei Wang and a team from the Mayo Clinic discuss recent advances in the field of pharmacogenomics and the potential value that it holds for patient care with proper uptake by the medical community.

Pharmacogenomics is the study of a patient’s response to a particular drug based on their genetic profile. Single nucleotide polymorphism (SNP) variations can lead to an individual either having increased or decreased sensitivity to a drug thereby changing the person’s expected reaction to the drug’s administration. Such information can be incredibly useful for tailoring patient care for an individual, decreasing the financial burden on the medical system or increasing the chances of success for a company sponsored clinical trial.

With regards to patient care, knowing in advance how a patient will respond to a drug or a particular dose of that drug will enable clinicians to make prescribing decisions that are in-line with that patient’s individual needs.

Pharmacogenomic data will enable the medical system (whether government, insurance or individually sponsored) to save billions of dollars in drug costs as standard treatments become tailored to individual needs thus decreasing the number of prescriptions that are either doomed to fail or prescribed in too high a dose based on the patient’s pharamcogenomic profile.

Clinical trials will also benefit from utilizing pharmacogenomic data as patients will be pre-screened to see if they are potential responders to the given therapy thereby reducing the number of non-responders and increasing the statistical significance of the trial.

Wang cites several examples of pharmacogenomic data that has been proven in genome wide association studies (GWAS) to be of potential clinical use. These include:

  • the prescription of warfarin as an anticoagulant which can cause hemorrhaging in individuals with several gene variants
  • the use of Clopidogrel to treat platelet aggregation which is largely ineffective in patients with a particular SNP
  • the use of Floxacillin to treat staph infection
  • the use of numerous anti-cancer drugs and therapies with respond differently in individuals with varying pharmacogenomic profiles

Unfortunately, despite the discovery of these pharmacogenomic effects and the publication of FDA guidelines associated with these drugs, pharamacogenomic data continues to be widely underutilized in clinical decision making . Hopefully as the cost of acquiring patient genomic data decreases and the practice of acquiring such data increases, we will see more widespread use of pharmacogenomics in the clinical arena.

Reference:
Wang L, McLeod HL, & Weinshilboum RM (2011). Genomics and drug response. The New England journal of medicine, 364 (12), 1144-53 PMID: 21428770

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