How can understanding a resident’s genetics help doctors choose the right medication and dose?
myDNA is one of Australia’s leading providers in personalised medicine known as pharmacogenomics. So what is it?
Pharmacogenomics is the branch of genetics which looks at the likely response of an individual to therapeutic drugs.
Once a person’s likely response to medication is known, a doctor can decide how best to tailor the drug treatment to match a person’s genetic profile.
The Benefits of Pharmacogenomics in Aged Care
Currently, over one million elderly take five or more regular medicines , contributing to approximately 250,000 hospital admissions annually, of which two-thirds are believed to be preventable1.
Previous report findings have indicated that up to 50 per cent of residential aged care (RAC) residents had been prescribed one or more potentially inappropriate medications, and over 90 per cent of residents faced at least one medication-related problem2.
Medication related harm is a significant risk factor for the elderly, and by integrating cutting-edge genetic science with clinical practice, safer and more effective care can be delivered to Age Care residents. Through pharmacogenomics, medication prescription and administration by tailoring medications and dosage to the individual resident, can be better managed by reducing unnecessary side effects.
What is pharmacogenomics
There are certain genes which contain instructions to build enzymes which, in turn, helps the body to break down medications, primarily in the liver. Every individual’s genetic makeup comprises variations of each of these protein producing genes. Each gene will also present varying levels of activity (e.g. slow, normal or fast), and as a result, individuals vary in how slow or fast they break down and clear medications from their body.
This test can aid in the clinical understanding of a patient’s predisposition to metabolise medications.
How is pharmacogenomics being used?
Doctors are using pharmacogenomics to guide their treatment of patients particularly for mental health treatment including depression, anxiety, ADHD and other psychiatric conditions when prescribing a range of drugs including antidepressants, antipsychotics and dexamphetamine.
Genetic testing has also been used to reduce the number of people suffering side effects, from pain, gastrointestinal and cardiovascular medications which may help doctors to establish the right dose for common medications.
Medication response
Humans share around 99.5 per cent of their genomes. The 0.5 per cent that differs between each of us affects our susceptibility to disease and our response to drugs.
People respond differently to medicines. Most respond well and their health improves. Some do not gain any benefits, and a minority suffer side effects. How your body metabolises drugs is determined in part by your genes. Understanding an individual’s genetics could help doctors to more accurately determine which drug and which dose is best for a patient.
How do we test the DNA?
myDNA use a simple cheek swab test to gather genomic information. Once the results are available, the doctor will look at how your genetic profile impacts the way medications are processed, and the doctor might wish to alter prescriptions based on the information provided in the report. All results are delivered directly to a nominated doctor or pharmacist and can be released following a consultation, allowing multiple healthcare practitioners to access the report.
What is the evidence base that supports our recommendations?
Our recommendations for tailoring medication according to genotype are supported by several international bodies, such as the Clinical Pharmacogenetics Implementation Consortium (CPIC), the Royal Dutch Association for the Advancement of Pharmacy – Pharmacogenetics Working Group and specific professional societies.
Clinical Trial In Aged Care
There is currently a clinical trial underway with the The University of Sydney, Whiddon, Choice Aged Care, Arrotex Pharmaceuticals and myDNA where myDNA pharmacogenomic testing service will be utilised to guide prescribing medications for 200 participating aged care residents. This two-year study aims to evaluate the feasibility, impact and cost effectiveness of implementing a pharmacogenomic testing service for residents in the aged care setting.
By integrating PGx into aged care settings, the study could help prevent a significant portion of these hospitalisations, improving residents’ quality of life and reducing healthcare costs
References
1Lim R, Ellett LMK, Semple S, Roughead EE. The Extent of Medication-Related Hospital Admissions in Australia: A Review from 1988 to 2021. Drug Saf. 2022;45(3):249-57.
2Roughead, E., Semple, S. & Rosenfeld, E. 2013, Literature review: Medication Safety in Australia, Australian Commission on Safety and Quality in Health Care.