Millions of UK patients could benefit from genetic screening before prescribing
The University of East Anglia (UEA) has carried out a new study which finds that millions of UK patients could benefit from genetic screening before being prescribed common medications including antidepressants, stomach ulcer treatments and painkillers.
As more than 95 per cent of the population carry a genetic marker that predicts an atypical response to at least one medicine, one would hope a policy of genetic screening as standard (a simple cheek swab that collects DNA for analysis), should be adopted as soon as possible.
While there are costs attached to such testing, this would be far outweighed by the benefits of avoiding prescribing errors and the resultant implications for the patient and the NHS: the survey found that around four million patients annually in the UK could benefit from genetic testing before being prescribed common medicines.
The BMJ (British Medical Journal) suggests 237+ million medication errors are made every year in England costing the NHS upwards of £98 million and more than 1,700 lives. Anything to reduce these human and financial costs should be welcomed.
Drug-gene testing is called pharmacogenetics or pharmacogenomics.
The concept is not new and is already embraced in some countries and clinics as can be seen from this informative video produced by the Mayo Clinic which stresses the importance of:
“The Right Drug, for the Right Patient, at the Right Dose”
The words pharmacogenetics or pharmacogenomics come from the combined words pharmacology (the study of the uses and effects of medications) and genetics or genomics (the study of genetics/genomics)
The history of pharmacogenetics
The history of pharmacogenetics can be traced back to 510BC when Pythagoras noted that ingestion of fava beans resulted in a potentially fatal reaction in some, but not all, individuals
In 1866 Medel established the basic rules of heredity, but the bulk of the research took place in the early and mid-20th century, with the term pharmacogenetics being coined by Vogel in 1957.
However, it was not until the beginning of this century and the success of the Human Genome Project, which established the complete DNA sequencing of the human body, that pharmacogenetics has really come to the fore.
The UEA study
In the UEA study, researchers looked through 2019 NHS dispensing data across the UK to see how many patients are started on new prescriptions each year that could be potentially optimised by genetic testing before prescribing.
They studied nine specific genetic markers 56 medicines where there are known drug-gene interactions including antidepressants, antibiotics, stomach ulcer treatments and painkillers.
They found that in more than one in five occasions (21.1 per cent) there was the potential for a doctor or pharmacist to take action under international pharmacogenetic guidelines.
If this screening was applied to all new prescriptions, an estimated one in 11 (9.1 per cent) would lead to a change of drug or dose, affecting over five million dispensed items.
Depending on the results of individual pharmacogenetic tests, patients might either get a higher or lower starting dose than normal or be more closely monitored during the early stages of treatment – resulting in more effective prescribing and better patient outcomes.
Essra Youssef, a research pharmacist at UEA’s School of Pharmacy, said:
“Better selection of medicines based on a patient’s genetic information could mean less side-effects and better treatment outcomes. This not only benefits the patient but also the NHS, as patients may not need to return to their GP so often to change their medication.
“It could also reduce hospital visits related to side effects of medicines. The testing process is quite simple in most cases, with a cheek swab sample collected and DNA analysed for genes related to medicines. As the cost of this testing continues to drop, the technology is more likely to represent good value for the NHS.”
Marc Donovan, Chief Pharmacist at Boots UK, said: “We strongly believe that pharmacy has a key role to play supporting the wider accessibility and use of pharmacogenomics.
“Our work shows the benefits that patients and the NHS could get from rolling out a national screening programme as part of their plans to embed pharmacogenomics in clinical practice by 2025, and that this testing could be effectively delivered by community pharmacists.
“Last year, around four million people could have had a change in their prescribing, according to our figures. This would have reduced their risk of side effects and could have led to better clinical outcomes.”
Genetic and genomic testing is currently available on the NHS, but only in very limited circumstances.
Although at Healthy Life Essex we acknowledge there is a place for prescribed medications, we have highlighted concerns about prescribing issues for many years including, but not limited to, overprescribing of antibiotics, dangers of Z-drugs for dementia patients, addictive opioids prescribed for chronic pain, over-medication of people with learning difficulties and more….
We welcomed the introduction of Clinical Pharmacists to GP practices as a first step to reduce over-prescribing and prescribing errors and hope that genetic screening before prescribing will soon be introduced on a wide-scale basis.