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Pharmacogenomics
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Pharmacogenomics in the UK National Health Service: opportunities and challenges

    Richard M Turner

    Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, L69 3GL, UK

    ,
    William G Newman

    Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK

    ,
    Elvira Bramon

    Division of Psychiatry, University College London, Charles Bell House, 67–73 Riding House Street, London, W1W 7EJ, UK

    ,
    Christine J McNamee

    Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, L69 3GL, UK

    ,
    Wai Lup Wong

    East & North Hertfordshire NHS Trust, Coreys Mill Lane, Stevenage, SG1 4AB, UK

    ,
    Siraj Misbah

    John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK

    ,
    Sue Hill

    NHS England, Skipton House, 80 London Road, London, SE1 6LH, UK

    ,
    Mark Caulfield

    William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London, EC1M 6BQ, UK

    &
    Munir Pirmohamed

    *Author for correspondence:

    E-mail Address: munirp@liverpool.ac.uk

    Department of Pharmacology & Therapeutics, University of Liverpool, Liverpool, L69 3GL, UK

    Published Online:https://doi.org/10.2217/pgs-2020-0091

    Despite increasing interest in pharmacogenomics, and the potential benefits to improve patient care, implementation into clinical practice has not been widespread. Recently, there has been a drive to implement genomic medicine into the UK National Health Service (NHS), largely spurred on by the success of the 100,000 Genomes Project. The UK Pharmacogenetics and Stratified Medicine Network, NHS England and Genomics England invited experts from academia, the healthcare sector, industry and patient representatives to come together to discuss the opportunities and challenges of implementing pharmacogenomics into the NHS. This report highlights the discussions of the workshop to provide an overview of the issues that need to be considered to enable pharmacogenomic medicine to become mainstream within the NHS.

    References

    • 1. Spear BB, Heath-Chiozzi M, Huff J. Clinical application of pharmacogenetics. Trends Mol. Med. 7(5), 201–204 (2001).
    • 2. Pirmohamed M, James S, Meakin S et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients. BMJ 329(7456), 15–19 (2004).
    • 3. Davies EC, Green CF, Taylor S, Williamson PR, Mottram DR, Pirmohamed M. Adverse drug reactions in hospital in-patients: a prospective analysis of 3695 patient-episodes. PLoS ONE 4(2), e4439 (2009).
    • 4. NHS England. Medicines Value Programme. (2020). https://www.england.nhs.uk/medicines/value-programme/
    • 5. UK Pharmacogenetics and Stratified Medicine Network. Pharmacogenetics in the NHS workshop presentations. (2018). http://www.uk-pgx-stratmed.co.uk/index.php/february-2018-workshop-videos
    • 6. FDA. Table of pharmacogenomic biomarkers in drug labeling. (2020). https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling
    • 7. Bank PCD, Caudle KE, Swen JJ et al. Comparison of the guidelines of the Clinical Pharmacogenetics Implementation Consortium and the Dutch Pharmacogenetics Working Group. Clin. Pharmacol. Ther. 103(4), 599–618 (2018).
    • 8. Relling MV, Evans WE. Pharmacogenomics in the clinic. Nature 526(7573), 343–350 (2015).
    • 9. Genomics England. The 100,000 Genomes Project. (2020). https://www.genomicsengland.co.uk/about-genomics-england/the-100000-genomes-project/
    • 10. Genomics England. How can we make cancer treatment less toxic? (2020). https://www.genomicsengland.co.uk/how-can-we-make-cancer-treatment-less-toxic/
    • 11. Centre for Addiction and Mental Health. Individualized medicine: pharmacogenetic assessment & clinical treatment. (2020). http://impact.camhx.ca/en/home.php#
    • 12. Osanlou O, Pirmohamed M, Daly AK. Pharmacogenetics of adverse drug reactions. Adv. Pharmacol. 83, 155–190 (2018).
    • 13. Pirmohamed M, Ostrov DA, Park BK. New genetic findings lead the way to a better understanding of fundamental mechanisms of drug hypersensitivity. J. Allergy Clin. Immunol. 136(2), 236–244 (2015).
    • 14. Plumpton CO, Pirmohamed M, Hughes DA. Cost-effectiveness of panel tests for multiple pharmacogenes associated with adverse drug reactions: an evaluation framework. Clin. Pharmacol. Ther. 105(6), 1429–1438 (2019).
    • 15. Alfirevic A, Pirmohamed M. Genomics of adverse drug reactions. Trends Pharmacol. Sci. 38(1), 100–109 (2017).
    • 16. Rauch A, Nolan D, Martin A, McKinnon E, Almeida C, Mallal S. Prospective genetic screening decreases the incidence of abacavir hypersensitivity reactions in the Western Australian HIV cohort study. Clin. Infect. Dis. 43(1), 99–102 (2006).
    • 17. Pavlos R, Mallal S, Ostrov D et al. T cell-mediated hypersensitivity reactions to drugs. Annu. Rev. Med. 66, 439–454 (2015).
    • 18. Kapoor R, Martinez-Vega R, Dong D et al. Reducing hypersensitivity reactions with HLA-B*5701 genotyping before abacavir prescription: clinically useful but is it cost-effective in Singapore? Pharmacogenet. Genomics 25(2), 60–72 (2015).
    • 19. Tan O, Shrestha R, Cunich M, Schofield DJ. Application of next-generation sequencing to improve cancer management: a review of the clinical effectiveness and cost–effectiveness. Clin. Genet. 93(3), 533–544 (2018).
    • 20. Pirmohamed M, Burnside G, Eriksson N et al. A randomized trial of genotype-guided dosing of warfarin. N. Engl. J. Med. 369(24), 2294–2303 (2013).
    • 21. Zhou Y, Armstead AR, Coshatt GM, Limdi NA, Harada S. Comparison of two point-of-care CYP2C19 genotyping assays for genotype-guided antiplatelet therapy. Ann. Clin. Lab. Sci. 47(6), 738–743 (2017).
    • 22. van der Wouden CH, Bohringer S, Cecchin E et al. Generating evidence for precision medicine: considerations made by the Ubiquitous Pharmacogenomics Consortium when designing and operationalizing the PREPARE study. Pharmacogenet. Genomics 30(6), 131–144 (2020).
    • 23. van der Wouden CH, Cambon-Thomsen A, Cecchin E et al. Implementing pharmacogenomics in Europe: design and implementation strategy of the Ubiquitous Pharmacogenomics Consortium. Clin. Pharmacol. Ther. 101(3), 341–358 (2017).
    • 24. Rasmussen-Torvik LJ, Stallings SC, Gordon AS et al. Design and anticipated outcomes of the eMERGE-PGx project: a multicenter pilot for preemptive pharmacogenomics in electronic health record systems. Clin. Pharmacol. Ther. 96(4), 482–489 (2014).
    • 25. NHS England. NHS genomic medicine service. (2020). https://www.england.nhs.uk/genomics/nhs-genomic-med-service/
    • 26. NHS England. Sustainability and transformation partnerships. (2020). https://www.england.nhs.uk/integratedcare/stps/
    • 27. Miller DM, Daly C, Aboelsaod EM et al. Genetic epidemiology of malignant hyperthermia in the UK. Br. J. Anaesth. 121(4), 944–952 (2018).
    • 28. Cicali EJ, Weitzel KW, Elsey AR et al. Challenges and lessons learned from clinical pharmacogenetic implementation of multiple gene–drug pairs across ambulatory care settings. Genet. Med. 21(10), 2264–2274 (2019).
    • 29. Wang L, Weinshilboum R. Pharmacogenomics in practice. Clin. Pharmacol. Ther. 106(5), 936–938 (2019).
    • 30. Hoffman JM, Haidar CE, Wilkinson MR et al. PG4KDS: a model for the clinical implementation of pre-emptive pharmacogenetics. Am. J. Med. Genet. C Semin. Med. Genet. 166C(1), 45–55 (2014).
    • 31. Bell GC, Crews KR, Wilkinson MR et al. Development and use of active clinical decision support for preemptive pharmacogenomics. J. Am. Med. Inform. Assoc. 21(e1), e93–e99 (2014).
    • 32. Just KS, Steffens M, Swen JJ, Patrinos GP, Guchelaar HJ, Stingl JC. Medical education in pharmacogenomics-results from a survey on pharmacogenetic knowledge in healthcare professionals within the European pharmacogenomics clinical implementation project Ubiquitous Pharmacogenomics (U-PGx). Eur. J. Clin. Pharmacol. 73(10), 1247–1252 (2017).
    • 33. Higgs JE, Andrews J, Gurwitz D, Payne K, Newman W. Pharmacogenetics education in British medical schools. Genomic Med. 2(3–4), 101–105 (2008).
    • 34. Maxwell SRJ, Coleman JJ, Bollington L, Taylor C, Webb DJ. Prescribing Safety Assessment 2016: delivery of a national prescribing assessment to 7343 UK final-year medical students. Br. J. Clin. Pharmacol. 83(10), 2249–2258 (2017).
    • 35. Health Education England. HEE Genomics Education Programme. (2020). https://www.genomicseducation.hee.nhs.uk/