Pharmacogenomics: Implementation in Pharmacy Practice

The topic of implementing pharmacogenomics in practice was a well-attended session at this year’s International Pharmaceutical Federation (FIP) World Congress in Glasgow Scotland. During this discussion, the speakers reviewed principles of pharmacogenomics and demonstrated useful strategies for utilizing pharmacogenomics in a clinical setting.

The first speaker was Yolande Saab, PharmD, PhD., an associate professor at the Lebanese American University in Lebanon. She identified pharmacogenomics as the science of using a patients’ own genetics to help in predicting the individuals’ response to a medication. By having this genetic understanding, we can increase drug efficacy and prevent toxic side effects.

The FDA and several other global regulatory agencies have recently approved pharmacogenetic testing and have required the updating of certain drug labels in response. Saab mentioned that while there are challenges in the implementation of clinical pharmacogenomics, the role of pharmacists will be to move the use of medications from the trial and error phase towards ever more specific and individualized drug therapies for the patient.

John Papastergiou, BSc, BScPhm, a pharmacist for Shoppers Drug Mart in Canada, presented on his findings bringing pharmacogenomics to community practice. The objective of this was to determine the feasibility of implementing personalized medication services into practice, and to assess the number of therapy problems identified through screening. His presentation detailed the programs initial barriers and ultimate results.

In his practice, patients were offered pharmacogenomic screening as a service program. Patients who were eligible received buccal swabs. These were analyzed by a third-party and provided valuable insight into a patient’s inherited metabolic profile. The pharmacists reviewed and interpreted the results with the patients. Any potential, clinically significant medication issues were identified, and recommendations for optimization were forwarded to the patient’s health care provider.

The results of his research were telling: on average 1.3 drug therapy problems directly related to pharmacogenomic testing were found per patient. The most common reasons for patients to be interested in the service were due to ineffective therapy, to address an adverse reaction, and to guide new therapy. The findings demonstrated the ability of community pharmacists to develop and deliver personalized medication services and interpret genomic results.

Jill Kolesar, PharmD, a professor of pharmacy at the University of Kentucky, rounded out the discussion in Glasgow by describing her work developing a multidisciplinary team to better address testing and interpretation of genetic sequencing reports. Due to the challenges of somatic mutation testing for treating clinicians, her team established the Molecular Tumor Board (MTB) to assist in this task.

The MTB is a team consisting of medical oncologists, molecular pathologists, radiologists, pharmacists, and genetic counselors. Meetings are held twice monthly, and patients who are reviewed by the MTB are also offered enrollment in clinical trial.

In the first year of the MTB, the majority of patients who received board recommended therapy had improved progression free survival compared to their immediate prior therapy. She said this demonstrates the clinical benefit of implementation for this type of approach.

Pharmacists are ideally suited to offer pharmacogenomic screenings and this early experience is promising. Additionally, patient feedback has been positive. According to the presenters, the keys to success are interprofessional collaboration and comprehensive training.

In response to the presentation, Fred Eckel, RPh, MS, and Editor Emeritus of Pharmacy Times, said pharmacogenomics has been viewed as a possibility to improve drug therapy outcomes for quite some time, leading some pharmacists to wonder if it would be a feasible idea for practice. However, he said, progress in pharmacy practice often come in small steps and can take years to develop.

"This symposium demonstrated that pharmacogenomics does have real value to selected patients," he said. "Pharmacy needs some risk takers who are willing to be early adopters to demonstrate that pharmacogenomics has value. We need to appreciate these pharmacists, as demonstrated by the speakers at this symposium. Yes, pharmacogenomics will be more important in the future and pharmacists have a real contribution to it. What an exciting time to be a pharmacists."

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