RON VAN SCHAIK
Erasmus MC, Clinical Chemistry, Rotterdam, Netherlands
Adverse drug reactions are responsible for 5-7% of hospitalizations each year. Interindividual variation in drug metabolism is a factor affecting successful drug therapy. Predicting the capacity of patients to metabolize drugs based on their DNA profile, targeting genetic polymorphisms in drug metabolizing enzymes will allow prior adjustment of drug therapy to fit their personal genomic profile. With over 5,000 articles per year being published on genomic markers to guide drug therapy, there is a huge potential to use these to improve therapy. A number of these markers are ready for clinical implementation. Among these, the cytochrome P450 (CYP) enzymes that are involved in the metabolism of 80% of all drugs. For CYP2D6, involved in the degradation of 25% of drugs, 5-10% of the population is deficient due to inheritance of two inactive CYP2D6 variant alleles. Such a deficiency can be tested upfront, and drug therapy can be adjusted to personal DNA profile, thereby decreasing adverse drug reactions and improving effectivity of therapy.
Our 10 year experience in implementing pharmacogenetics in the Netherlands will be illustrated, covering the value of clinical evidence, education, availability of testing, laboratory and clinical guidelines, quality, feedback from clinicians and patients, reporting as well as financial and ethical aspects. Successes as well as unexpected challenges will be addressed. Also European initiatives such as the European Pharmacogenetics Implementation Consortium (www.eu-pic.net), the IFCC Task Force Pharmacogenetics and the European Society for Pharmacogenomics and Personalized Therapy (ESPT) (www.esptnet.org) will be highlighted.
The Erasmus MC provides since 2015 DNA passports for guiding medication, addressing a pre-emptive genotyping approach. With this passport, one can visit any pharmacy in the Netherlands to obtain medication adjusted on genomic profile for over 80 drugs. The question is, therefore: “Do YOU have your DNA-passport?”