Perspective

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

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

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Elvira Bramon

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

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Christine J McNamee

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

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Wai Lup Wong

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

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Siraj Misbah

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

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Sue Hill

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

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Mark Caulfield

https://orcid.org/0000-0001-9295-3594

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

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Munir Pirmohamed

*Author for correspondence:

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

https://orcid.org/0000-0002-7534-7266

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

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Published Online:29 Oct 2020https://doi.org/10.2217/pgs-2020-0091

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Abstract

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).
Medline CASGoogle Scholar
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).
MedlineGoogle Scholar
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).
MedlineGoogle Scholar
4. NHS England. Medicines Value Programme. (2020). https://www.england.nhs.uk/medicines/value-programme/
Google Scholar
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
Google Scholar
6. FDA. Table of pharmacogenomic biomarkers in drug labeling. (2020). https://www.fda.gov/drugs/science-and-research-drugs/table-pharmacogenomic-biomarkers-drug-labeling
Google Scholar
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).
Medline CASGoogle Scholar
8. Relling MV, Evans WE. Pharmacogenomics in the clinic. Nature 526(7573), 343–350 (2015).
Medline CASGoogle Scholar
9. Genomics England. The 100,000 Genomes Project. (2020). https://www.genomicsengland.co.uk/about-genomics-england/the-100000-genomes-project/
Google Scholar
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/
Google Scholar
11. Centre for Addiction and Mental Health. Individualized medicine: pharmacogenetic assessment & clinical treatment. (2020). http://impact.camhx.ca/en/home.php#
Google Scholar
12. Osanlou O, Pirmohamed M, Daly AK. Pharmacogenetics of adverse drug reactions. Adv. Pharmacol. 83, 155–190 (2018).
Medline CASGoogle Scholar
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).
Medline CASGoogle Scholar
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).
MedlineGoogle Scholar
15. Alfirevic A, Pirmohamed M. Genomics of adverse drug reactions. Trends Pharmacol. Sci. 38(1), 100–109 (2017).
Medline CASGoogle Scholar
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).
Medline CASGoogle Scholar
17. Pavlos R, Mallal S, Ostrov D et al. T cell-mediated hypersensitivity reactions to drugs. Annu. Rev. Med. 66, 439–454 (2015).
Medline CASGoogle Scholar
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).
Medline CASGoogle Scholar
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).
Medline CASGoogle Scholar
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).
Medline CASGoogle Scholar
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).
Medline CASGoogle Scholar
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).
MedlineGoogle Scholar
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).
MedlineGoogle Scholar
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).
Medline CASGoogle Scholar
25. NHS England. NHS genomic medicine service. (2020). https://www.england.nhs.uk/genomics/nhs-genomic-med-service/
Google Scholar
26. NHS England. Sustainability and transformation partnerships. (2020). https://www.england.nhs.uk/integratedcare/stps/
Google Scholar
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).
Medline CASGoogle Scholar
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).
MedlineGoogle Scholar
29. Wang L, Weinshilboum R. Pharmacogenomics in practice. Clin. Pharmacol. Ther. 106(5), 936–938 (2019).
MedlineGoogle Scholar
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).
MedlineGoogle Scholar
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).
MedlineGoogle Scholar
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).
MedlineGoogle Scholar
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).
MedlineGoogle Scholar
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).
MedlineGoogle Scholar
35. Health Education England. HEE Genomics Education Programme. (2020). https://www.genomicseducation.hee.nhs.uk/
Google Scholar

Vol. 21, No. 17

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History

Received 6 July 2020

Accepted 17 August 2020

Published online 29 October 2020

Published in print November 2020

Information

Author contributions

This report is based on a workshop that invited experts to come together in discussion groups to determine the opportunities to introduce pharmacogenetics into the UK NHS to improve healthcare; identify the challenges and offer solution on how best to overcome such challenges. RM Turner, WG Newman and E Bramon acted as chair/rapporteur for discussion groups, directing discussions and compiling reports of discussions, and edited the draft report. RM Turner also presented findings at the event. CJ McNamee organized/managed event, complied initial draft of report, incorporated rapporteur notes, comments and drafted final edit. WL Wong and S Misbah acted as rapporteurs of discussion groups contributing their notes of the discussions to the report, WL Wong offered comments on report. S Hill and M Caulfield were involved in the conception of the event, offered advice on content/format of the event and viewed final report. M Caulfield also presented findings at the event. They will be taking the findings of the event forward. M Pirmohamed offered advice on content/format of workshop, chaired and oversaw the event, presented findings, edited the initial draft and provided approval of the final version of the report to be published, acting as author for correspondence and will be taking findings of the event forward.

Disclaimer

The content of this article represents the collective views of the attendees rather than those of any individual organization represented at the workshop.

Financial & competing interests disclosure

The UK Pharmacogenetics and Stratified Medicine Network has received unrestricted educational grants from Bristol-Myers Squibb and UCB, but these funds were not utilized for this workshop. S Hill is Chief Scientific Officer for NHS England, while MC is Chief Scientist for Genomics England. WG Newman is director of the North West Genomics Laboratory Hub. M Pirmohamed has received infrastructure support from the MRC Centre for Drug Safety Science and HDR North, and is also involved in the EU-funded Ubiquitous Pharmacogenomics (U-PGx) project. M Pirmohamed also reports receipt of partnership funding for the MRC Clinical Pharmacology Training Scheme (co-funded by MRC and Roche, UCB, Eli Lilly and Novartis); a PhD studentship jointly funded by EPSRC and Astra Zeneca; and grant funding from Vistagen Therapeutics. He has developed an HLA genotyping panel with MC Diagnostics, but does not benefit financially from this. None of the funding declared was used for the workshop or current paper. Disclose any financial interests. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

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Pharmacogenomics in the UK National Health Service: opportunities and challenges

Abstract

References