According to Mayo Clinic's Dr. Richard Weinshilboum & Dr. Liewei Wang, pharmacogenomics – how your genes affect the way you respond to medications – is an area of precision medicine that will touch every medical specialty and every patient.
This article appears on the Individualizing Medicine blog.
When prescribing a medication for you, your physician considers many factors, including your age, sex, weight and current health conditions. Now, add to that list your unique genetic characteristics. Your genes affect the way you respond to medications. Pharmacogenomics is a term used to describe the use of genomic information to help select the right medication for patients to maximize the treatment benefit and avoid harmful, sometimes life-threatening side effects.
It turns out that virtually everyone has a genetic variant that will affect the way they respond to one or more medications. Pharmacogenomics is already making a difference by helping individualize treatments for cancer, pain management, transplants and depression.
“This area of clinical genomics applies to every medical specialty and will eventually touch the care of every patient. While we are just at the beginning of understanding how genomics affect drug response, research has shown the benefit of using pharmacogenomics in clinical care. Pharmacogenomics information is being generated in clinical laboratories, added to electronic health records and used to ‘tailor’ or individualize therapy for patients,” says Mayo Clinic’s Richard Weinshilboum, M.D.
Dr. Weinshilboum and Liewei Wang, M.D., Ph.D., are leading pharmacogenomics researchers and co-directors of the Mayo Clinic Center for Individualized Medicine Pharmacogenomics Program. In the November issue of Mayo Clinic Proceedings, Dr. Weinshilboum and Dr. Wang trace the origins and development of pharmacogenomics and highlight the progress and challenges of implementing it into clinical practice. In their paper Pharmacogenomics: Precision Medicine and Drug Response, they describe a vision for the future where pharmacogenomics will become “pharmaco-omics” in which other biological factors along with genomics are used to guide every medical drug-related therapy decision.
Using pharmacogenomics in patient care – progress and challenges
The challenge of using pharmacogenomics in clinical care is identifying the most cost-effective and efficient way to:
The authors highlighted several pilot studies underway that are testing these processes, including those at Mayo.
Currently, information for 19 drug-gene pairs is already added to Mayo's electronic health record. This information can trigger an alert along with clinical guidelines to any clinician prescribing a medication in which a patient’s genomics could affect their response to the drug.
“While having drug-gene information incorporated into the electronic health record is helpful, clinicians may still need to order genetic testing for a patient before they can use this information, potentially delaying treatment decisions. Through the RIGHT 10K study, we are investigating the benefit of pre-emptively adding a patient’s genomic information, along with clinical guidelines on how to interpret and use this information. This allows clinicians to have information they need when prescribing medications,” explains Dr. Wang.
The future – new discoveries will enhance individualized care
Going forward, the authors forecast that many new discoveries will help guide drug selection, including:
The challenge will be to develop computational tools and computer systems to analyze, interpret and then translate this wealth of information into guidelines to help physicians select the most effective medication for each individual patient.
According to the authors, despite these challenges, this area of precision medicine has the potential to help every patient.
Mayo Clinic Proceedings Symposium on Precision Medicine
This paper is the seventh in the Mayo Clinic Proceedings Symposium on Precision Medicine, a series of articles that cover a wide range of topics in personalized medicine. Watch for upcoming articles in the symposium, which will focus on how personalized medicine and genomics are impacting patient care. Learn more about the series.
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