Pharmacogenomics. One drug does not fit all.
Today adverse drug response is the 6th most common cause of death in the United States. Pharmacogenomics has the potential to dramatically reduce the estimated 100,000 deaths and 2 million hospitalizations that occur each year in the United States as a result of adverse drug responses (ADRs).(1).
The ability to personalize drugs for a patient's genetic makeup is rapidly becoming a reality. As pharmacogenics advances, the process of prescribing and dispensing drugs will become more complicated when multiple pharmacogenomic products are available to treat the same condition for different population subsets. In order to avoid adverse ADR's and determine the most effective treatment for a patient, all prescribing physicians, regardless of specialty, will need to execute extra diagnostic steps.
Targeted drug therapy for cancers based on genomic analysis is already taking place. In a recent paper published in Nature, it was established that 64% of squamous cell lung cancers had a potential therapeutic drug based on a targetable gene. This finding may be applicable to most cancers. The hope would be to minimize drug toxicity and improve overall survival for patients, basing therapy on genomic information rather than conventional diagnostic measures.
Drug dosages in the past have been determined by a host of factors including weight and age and clinical experience. Now dosages can be futher refined with genetic information. A person's genetic profile can show how their body processes and metabolizes the medicine. When dosage is based upon a person's genetic information, an adverse event may be less likely to occur.
Matching the drug to the genetic lesion instead of the disease
Recent examples like Kalydeco™ (ivacaftor) for treatment for a specific mutation that causes Cystic Fibrosis, CF G551D, and arbaclofen for treatment of Fragile X syndrome offer hope to patients that had limited therapuetic treatment options previously.
- Liewei Wang, M.D., Ph.D., Howard L. McLeod, Pharm.D., and Richard M. Weinshilboum, M.D. Genomics and Drug Response. New England Journal of Medicine 2011 Mar 24;364(12):1144-53.
- PharmGKB: The Pharmacogenetics and the Pharmacogenomics Knowledge Base- A tool designed to help researchers understand how genetic variations among individuals contribute to their differences in responses to drugs.
- NIH NIGMS Pharmacogenetics Research Network
- FDA’s Table of Pharmacogenomic Biomarkers in Drug Labels
1. J. Lazarou, B. H. Pomeranz, and P. N. Corey. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. Apr 15, 1998. 279(15):1200-5.2. J. Hodgson, and A. Marshall. Pharmacogenomics: will the regulators approve? Nature Biotechnolgy. 16: 243-246. 19983. S. Pistoi. Facing your genetic destiny, part II. Scientific American. February 25, 2002.