Estimating the potential impact of implementing pre-emptive pharmacogenetic testing in primary care across the UK

Youssef, Essra; Kirkdale, Charlotte L.; Wright, David J.; Guchelaar, Henk Jan; Thornley, Tracey

Abstract

Aims: Pharmacogenetics (PGx) in the UK is currently implemented in secondary care for a small group of high-risk medicines. However, most prescribing takes place in primary care, with a large group of medicines influenced by commonly occurring genetic variations. The goal of this study is to quantitatively estimate the volumes of medicines impacted by implementation of a population-level, pre-emptive pharmacogenetic screening programme for nine genes related to medicines frequently dispensed in primary care in 2019.

Methods: A large community pharmacy database was analysed to estimate the national incidence of first prescriptions for 56 PGx drugs used in the UK for the period 1 January–31 December 2019. These estimated prescription volumes were combined with phenotype frequency data to estimate the occurrence of actionable drug–gene interactions (DGI) in daily practice in community pharmacies.

Results: In between 19.1 and 21.1% (n = 5 233 353–5 780 595) of all new prescriptions for 56 drugs (n = 27 411 288 new prescriptions/year), an actionable drug–gene interaction (DGI) was present according to the guidelines of the Dutch Pharmacogenetics Working Group and/or the Clinical Pharmacogenetics Implementation Consortium. In these cases, the DGI would result in either increased monitoring, guarding against a maximum ceiling dose or an optional or immediate drug/dose change. An immediate dose adjustment or change in drug regimen accounted for 8.6–9.1% (n = 2 354 058–2 500 283) of these prescriptions.

Conclusions: Actionable drug–gene interactions frequently occur in UK primary care, with a large opportunity to optimise prescribing.

Citation

Youssef, E., Kirkdale, C. L., Wright, D. J., Guchelaar, H. J., & Thornley, T. (2021). Estimating the potential impact of implementing pre-emptive pharmacogenetic testing in primary care across the UK. British Journal of Clinical Pharmacology, 87(7), 2907-2925. https://doi.org/10.1111/bcp.14704

• Journal Article Type: Article
• Acceptance Date: Dec 7, 2020
• Online Publication Date: Jan 19, 2021
• Publication Date: 2021-07
• Deposit Date: Jan 14, 2023
• Publicly Available Date: Jan 17, 2023
• Journal: British Journal of Clinical Pharmacology
• Print ISSN: 0306-5251
• Electronic ISSN: 1365-2125
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 87
• Issue: 7
• Pages: 2907-2925
• DOI: https://doi.org/10.1111/bcp.14704
• Public URL: https://nottingham-repository.worktribe.com/output/15939772
• Publisher URL: https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.14704