PJ view: Time for a conversation in pharmacy about genomic medicine

Healthcare systems are on the cusp of a genomic revolution, which has the potential to dismantle current ways of diagnosing and treating diseases.

We already have some incredibly clever medicines licensed in the UK that harness genetic information, such as chimeric antigen receptor T-cell (CAR-T) therapy to treat adults with lymphoma and onasemnogene abeparvovec (Zolgensma; Novartis Gene Therapies), a single dose treatment for babies with spinal muscular atrophy. And the NHS already offers free genetic testing for hundreds of different rare conditions, such as familial hypercholesterolaemia and Huntingdon’s disease.

However, genomics is not just about rare genetic diseases — the results of genetic testing are starting to become embedded in common areas of care. For instance, all patients with cancer are being routinely offered a genetic test to determine their susceptibility to side effects from chemotherapy with fluoropyrimidines.

This screening is expected to result in around 40% of patients either being started on a lower dose or being offered a different treatment altogether, owing to their genetic makeup. And, in Wales, there are plans to routinely offer molecular testing of tumours to all patients with cancer and tailor treatment in the next ten years.

However, this is likely to only be the beginning. We know that an individual’s genetics has an influence on their body’s ability to metabolise common drugs, such as statins, warfarin, proton pump inhibitors, antidepressants and opioids. But while current prescribing approaches include a degree of individual tailoring based on factors, such as age, weight, biochemical markers and comorbidities, we do not yet adjust these medicines to reflect individual genetic differences.

This is likely to change in the years ahead. The NHS has the ambition of sequencing 5 million genomes by 2023 to extend the use of genetic data to help more precisely diagnose and target many other illnesses and in England chief and lead pharmacists have been appointed in all regions to begin the process of testing and rolling out new projects under the NHS Genomic Medicine Service.

In the future, pharmacy professionals can expect to be asked to interpret how treatment should change in the light of information from genetic testing and help patients navigate the complicated ethical and scientific questions around the use of testing and treating in this area.

That is why The Pharmaceutical Journal is today launching a new initiative. The #PJgenomics project aims to start a professional-wide conversation about what genomic medicine could mean for day-to-day practice and explore its potential implications for pharmacy professionals.

Over the next few months, we want to inspire and educate pharmacy professionals about the potential of genomic medicine to revolutionise patient care in the years ahead, and also the profession about the science behind it and any potential pitfalls there may be.

As part of this, we have launched a survey to find out what UK pharmacy professionals think about genomic medicine, the barriers you face and the educational materials you would like us to create. The results of this survey will be published later in 2022 — please click here to take part.

As part of the Royal Pharmaceutical Society, which is also planning support for pharmacy professionals in this area in 2022, we aim to ensure that the profession is open and ready for the exciting changes that are coming in the years ahead.

Therefore, we are also launching a ‘Call for papers’ on genomic medicine to gather as much experience, opinion and best practice as possible from pharmacy professionals on this topic. If you have anything you would like to write about, or you just want to submit some ideas on what it is you would like to see us cover, see the box below.

Everyone is invited to participate and we look forward to seeing the ideas that this generates. PJ