The bioscience sector is playing an important role in improving the way patients are prescribed their medication. The development of new sequencing techniques, data analysis software tools, and companion diagnostics for novel drugs by the bioscience sector are allowing clinicians to offer their patients a more precise diagnosis based on the molecular and genetic profile of their disease, rather than the traditional way of prescribing treatment based on the signs and symptoms of disease displayed by the patient. Advances at the pace of sequencing technologies increase the opportunity to incorporate pharmacogenomics (the understanding of how the patient’s genomic profile affects their response to drug therapies) into the prescribing process. The combination of a more precise diagnosis and the inclusion of pharmacogenomics data enables physicians to offer their patients the most appropriate drug, at the optimum dose, safely, and takes into account any polypharmacy requirements. Providing patients the drug most likely to be of benefit at the onset of treatment is described as offering personalised / precision / stratified / P4 medicine.
Personalised medicine has the potential not only to significantly improve patient outcomes but also in some cases to make savings on the costs of their healthcare. Improving patient safety by reducing the number of patients at risk of adverse drug reactions (ADRs) is one area where pharmacogenomics makes a valuable contribution to improving patient care that offers cost saving opportunities. It has been estimated that ~8,000 hospital beds are occupied at any one time by patients who have suffered ADRs placing a significant financial burden on the NHS. Identifying these patients and offering them a safer alternative therapy would potentially reduce the 6% of all hospital admissions, and 13% of extended stays, that are directly due to ADRs. For example, using genomic data has predicted which patients are likely to suffer life threatening ADRs to the HIV drug abacavir. Variants in the HLA region of chromosome 6 have been linked to ADRs for ~ 30 different drugs. Another area where personalised medicine offers the potential to improve healthcare is by incorporating genomic data into family history records to predict those individuals at greater risk of common diseases such as cancer, heart disease etc. and then offering them lifestyle choices, or preventative therapies, to reduce their risk of disease. The NHS 5 year Forward View produced by Dame Sue Hill (NHS chief scientist) and the Genomic Medicine report by Dame Sally Davis (NHS chief medical officer) both support offering a more personalised medicine approach to patient care within the NHS.
The pharmaceutical industry is also recognising the importance of pharmacogenomics when designing clinical trials for the novel drugs of the future. It is well acknowledged that most block buster drugs are not effective
for a significant proportion of individuals and many drugs fail on demonstrating efficacy during phase 2/3 clinical trials. Improving the design of clinical trials by using pharmacogenomics to select those patients most likely to receive benefit from a novel drug reduces the number of patients required to demonstrate efficacy in a clinical trial. Reducing the number of patients that are required for a clinical trial not only lowers the high cost of the trial but also raises the possibility of speeding up the time it takes to get a novel drug to market.
The government Life Science Strategy, produced by Sir John Bell, was published in August 2017. The strategy sets out a vision of how the UK might exploit its existing strength and provides recommendations for the long term success of the life biosciences sector. However, the biosciences sector cannot work in isolation to move personalised medicine forward. Academic scientific research input is required to first determine the molecular and genetic basis to disease for the pharma industry to go on and develop the novel drugs of the future. Clinicians then play an essential role in conducting the clinical trials to determine which patients will benefit from new drug treatments, whilst the regulators oversee the process to ensure patient safety. Patients providing their samples, access to their data, and contributing to determining a research strategy relevant to the needs of their condition, are a vital part of the process of developing more personalised drug treatments. Providing links across these different sectors to maximise the potential of personalised medicine in the UK is challenging. The UK Pharmacogenetics and Stratified Medicine Network is a not-for-profit organisation set up to help overcome that challenge and deliver personalised medicine into the clinic.
The Network was first set up in 2010 by Professor Sir Munir Pirmohamed and has the support of a steering committee made up of a cross section of experts from all sectors involved in the delivery of personalised medicine to patients. Since 2014 the Network has recruited ~1,000 members from academia, the bioscience, clinical and regulatory sectors, as well as patients. Our website http://www.uk-pgx-stratmed.co.uk/ attracts global attention, with many visitors returning regularly to browse our pages. Valuable information on the latest news on developments in the field, events taking place, and details of current funding opportunities are all provided on the website to create a “one stop shop” for all those interested in personalised medicine. Membership is free of charge and by adding their details to our online collaborator’s database individuals have the opportunity to highlight their expertise, and the interests of their organisation, to the wider community. Search facilities within the collaborators database offer members the opportunity to find colleagues from different sectors to develop multidisciplinary research partners to move their research forward. Important links to progress within the sector are promoted through social media and our blogs attract both UK and overseas followers.
Every year the Network holds an annual open meeting in March that highlights the cutting edge advances in the field of personalised medicine. The high quality of the speakers at these meetings, and opportunities to meet colleagues from other sectors, attract a diverse audience of those wishing to follow the progress of personalised medicine. However, it is recognised that the progress in the adoption of personalised medicine into the clinic is not without its challenges. By collaborating with Government and NHS affiliated organisations, such as the Academic Health Science Network, Academy of Medical Sciences, Genomics England, Medicines and Healthcare products Regulatory Agency, National Institute for Health and Care Excellence, National Institute of Health Research Clinical Research Network, the Pharmacogenetics and Stratified Medicine Network aims to address some of these challenges through focused workshops. These workshops bring together key opinion leaders from across all disciplines to discuss, and offer solutions to, the many different barriers faced in offering patients a personalised medicine approach to their healthcare. Reports from these workshops are sent for publication in peer reviewed journals to inform how personalised medicine moves forward into the clinic. Recordings of the presentations given at annual events and focused workshops are available on our website.
Engaging with the Network is an ideal way for the bioscience sector to make contact with colleagues from other sectors to develop collaborative partnerships and enhance research output. International links with other similar organisations, such as the European Society of Pharmacogenomics and Personalised Therapy, International Union of Basic and Clinical Pharmacology, European Ubiquitous Pharmacogenomics project and US Pharmacogenomics Research Network, have been established to develop a global approach for supporting the adoption of personalised medicine into the clinic. Plans are in place to develop an international network in which experiences of pharmacogenomics and advances in personalised medicine are shared across all nations. Browse the website or contact Christine McNamee cjmcn@liv.ac.uk for more information about our organisation.
Currently the Network receives generous financial support from the National Institute of Health Research-Clinical Research Network, the Northern Health Science Alliance and UCB pharma.
