Bumrungrad International Hospital set up an innovative drug prescription system in March 2020 that responds to a patient’s individual genetic makeup. Taking a proactive and personalized approach to healthcare, pharmacogenetics utilizes precision medicine. Doctors are alerted through an interactive software program to test a patient’s DNA before writing out a prescription through a targeted reactive testing approach. Meanwhile, the results of any screening already carried out via a broader, pre-emptive approach, before a specific drug prescription is identified, can be flagged up too. This speeds-up the process and ensures the
right medicine gets to the
right patients at the
right time.
The Power of Pharmacogenetics
Some gene profiles react adversely with certain medications, leading to allergic reactions, which in a number of cases can be extremely serious, as well as creating unwanted side-effects. Genes can also dictate the actual
efficacy of a prescribed drugs individually too, meaning a patient’s treatment path can be not only far from optimized but also compromised.
The Bumrungrad International Hospital Pharmacogenetics Team’s work, headed by Dr. Chonlaphat Sukasem, who is also an Associate Professor at Division of Pharmacogenomics and Personalized Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University connects to every branch of healthcare. This type of screening is evolving drug treatment in cardiology and oncology departments, as well as neurology, rheumatology and HIV, plus psychiatric care, etc.
At Bumrungrad International Hospital, genetic testing is being applied to determine medication prescribed in the treatment plans of those suffering with epilepsy, gout, cardiovascular diseases and acute lymphoblastic leukemia as well as in the area of pain management, infectious diseases and clinical practice. The test can be requested by check-up clinics too.
Doctors at the hospital can access the genetic profile of a patient to guide the selection of drugs and drug doses that would be optimally therapeutic for that individual’s condition as well as being safe with no side effects.
Bumrungrad’s Personalized Treatment Mission
The pharmacogenetics screening usually involves a buccal swab and blood test with a current turnaround time of three days, unless results are urgently required within 24 hours. Most tests are processed in-house, with some sent to labs abroad. In terms of drugs that can be tested, evidence-based guidelines are followed, focusing on around 270 USDFA recommended drugs. As new medications are developed the results from previous testing can be applied using the genetic profile information.
Such an individual focus aides specialists in selecting appropriate medicines and highlighting where any issues may occur. This allows for adjustments in drug combinations, enabling greater personalized treatment in terms of dosing, even if a particular drug is not intrinsically deemed high risk for that individual. While clinical trials ensure that dosing levels are suitable for the majority, it is the minority that can encounter issues and for whom pharmacogenetics provides a real-life solution.
When Drugs Cause More Harm than Good
The impact of a prescription not working properly when dealing with serious illnesses and disease is clear. With advances in the area of pharmacogenetics and drug development there are more choices and lack of efficacy can be avoided. Genetic variation can affect metabolism too and the knock-on effects of this can be adverse, from a low excretion rate to a toxic build-up.
Another problem that can occur is a reaction to medication that causes severe, burn-like skin reactions which can be life-threatening, with a relatively high mortality rate. Some 10-18% of Thais tested show some type of frequency of this ‘risk’ gene, for example. The future mission at Bumrungrad International Hospital is to screen patients as a default so that they can be stratified according to their genetic background.
Pharmacogenetics is ultimately about saving lives and promoting the best treatment possible. An example of this is the use of blood-thinning medicine Warfarin, which in some patients can cause bleeding. If an individual does not respond well to that drug, and they are a poor responder in terms of its efficacy, the result can lead to thrombosis which can prove fatal.
Prevention is Better than Cure
In screening to ensure optimized treatment, testing also comes into the pre-emptive arena too, of using pharmacogenetics to delay or avoid the onset of illness through early intervention. Results are implemented into the work of the Wellness Center, treating hypertension, for example, before it turns into a more serious cardiovascular disease.
Pharmacogenetics is not a magic wand but rather a golden thread that weaves into the fabric of physician medicine. Diet, general health and environment are all important strands as well. In the case of Warfarin, as an example, genetics is one factor and pharmacogenetics is an important tool, while diet plays into treatment options too.
Bumrungrad Hospital’s Pharmacogenetics Team comprises of 10 medical professionals, including pharmacogenetics experts, pharmacists and lab scientists. Their plan is to create a dream team that enables a proactive response to provide a healthcare treatment model of excellence within the world.