Genetic testing to drive personalised prescribing
Pinnacle Ventures has launched a pharmacogenomics programme to enable genetic testing to drive personalised prescribing decisions.
The innovation arm of Pinnacle Midlands Health Network, a not-for-profit primary health care management company in New Zealand, is also working on embedding biomarker information into electronic health records and linking it to a clinical-decision support prescribing tool that can help prescribers by providing direct access to international pathways and guidelines.
Pharmacogenetics involves prescriptions being tailored to a person’s genetic make-up, as people metabolise drugs in different ways, which can have a significant impact on a drug’s effectiveness.
Ventures plans to do about 5,000 pharmacogenetic tests over the next 12 months, says chief executive John Macaskill-Smith.
Some will be self-funded because individuals are struggling with their medications and others will be fully funded by Ventures, targeting specific groups within the Midlands population.
Macaskill-Smith says it is a simple test that covers 65–70 per cent of medications frequently prescribed in New Zealand.
“The New Zealand health system is under strain but using testing like this you could reduce the trial and error of prescribing and prevent adverse reactions to medications,” he said.
Ethnicity plays a big part in how a person metabolises drugs, but the clinical trials that prescribing information are based on very rarely involve Māori or Pasifika test subjects.
Macaskill-Smith said Ventures is partnering with key kiwi groups, Auckland University and Otago University medical schools and Callaghan Innovation to support research and develop a better understanding of how unique New Zealand populations respond to different medications.
People who have a pharmacogenetic test can choose to consent to contributing their non-identifiable demographic information to researchers.
Embedding the biomarker information into EHRs ensures a patient’s results are used for both current and future prescribing decisions, he said.
Macaskill-Smith says a lot of direct-to-consumer online genetic-testing tools involve people essentially “giving away their DNA” as there are no protections or consent processes for how the testing company might use it.
“You can lose ownership and visibility of where your DNA has gone. We are saying your DNA is yours and you should have control over it, so we are trying to promote safe and informed use of your genetic information by embedding it back into your own EHR,” he said.
“Seeing an individual’s health record shift away from being largely about providers recording notes around their activity to actually becoming a blueprint for an individual’s health and wellness information is incredibly exciting.
“This is the real health revolution that is about to occur, and including and using your DNA is core to this.”
A virtual training package to help primary care providers respond to this genetic information is also being offered.
The US Food and Drug Administration requires pharmaceutical companies to publish biomarker information in relation to how people with different genetic make-ups might respond to specific medications.
Many health providers in the US use pharmacogenomics as a key tool in treating their patients, and other places, such as Canada and the European Union, are heading in this direction.
The New Zealand government does not require this information to be published, but international curators have emerged and can be used to access individual drug information and treatment pathways to inform how doses should be altered according to people’s genetic make-up.