The science of pharmacogenomics—how individual genetics affects a person’s response to medicines—has matured enough that the creators of formularies need to start taking genetic data into consideration even though resources for doing so can be hard to find, according to researchers at the University of North Carolina at Chapel Hill.
Lindsey Poppe, PharmD, and Mary Roederer, PharmD, conducted a review of health databases to determine to what extent genetic information is being used to develop formularies. Formularies are drug policies established by health-care organizations to govern the use of medicines by hospitals, insurance companies, government programs, and other groups that provide health care. An example is the list of medications the World Health Organization finds essential to the treatment of disease in all countries. The health-care professionals creating these formularies weigh the efficacy, safety, and cost of drugs in determining which ones to include or exclude.
“Hundreds of articles are being published each year that reveal new genetic information, and there are nearly seventy drugs listed on the FDA Web site that have genetic information included in their packet inserts,” Roederer says. “If it’s in the insert, certainly drug formularies need to be taking the information into account.”
The researchers give a number of examples. Continued use of the HIV drug abacavir can lead to organ failure and death in the small percentage of the population that has a certain genetic marker. Breast cancer patients who produce one form of the enzyme CYP2D6 are less responsive to the drug tamoxifen. Asians, particularly Han Chinese, with a certain version of the gene HLA-B who take the antiseizure drug carbamazepine are at a greater risk of developing a condition where the upper and lower layers of skin separate from each
Unfortunately, Roederer says she and Poppe were unable to find any comprehensive resources to guide the creators of formularies in successfully integrating genetic information into lists of preferred drugs. The pair suggests considering pharmacogenetic information each time a drug is reviewed for addition to or deletion from a formulary by using online databases. Their findings and the following recommended resources were published in the April issue of Annals of Pharmacotherapy:
- Pharmacogenetics and Pharmacogenomics Knowledge Base
- WHO Essential Medicines List
- International Society for Pharmacoeconomics and Outcomes Research
Poppe is a board-certified pharmacotherapy specialist and a health-system pharmacy administration resident in the Department of Pharmacy at UNC Hospitals. Roederer is a research assistant professor in the UNC Eshelman School of Pharmacy and a member of the School’s Institute for Pharmacogenomics and Individualized Therapy. She is also a clinical assistant professor in the Department of Family Medicine at the UNC School of Medicine.