During the International Congress of the ISCP 2012, Dr Munir Pirmohamed from The University of Liverpool, Liverpool, UK, presented the Neufeld Lecture – the lecture title being ‘Pharmacogenomics: Ready for use in clinical practice?’. Here, Dr Pirmohamed talks to Cardio Debate about his presentation.
In order for pharmacogenomics to translate into clinical practice, there needs to be a movement from population-based studies towards a more individualised approach. As Dr Pirmohamed explains: “If you start looking at the data from population-based studies, you find that on a population-basis there is an efficacious response to a given drug. But within that efficacious response there is huge variability.”
“So the efficacy data is then extrapolated to clinical practice, where you have an individual patient in front of you and it’s sometimes difficult to say whether that drug will work in that patient,” he says, adding that what is needed is a way to stratify therapies so that patients recieve the best therapy with maximum efficacy and minimum toxicity.
In terms of pharmacogenomics and cardiovascular pharmacotherapy, much work still needs to be done. “There has been a lot of work in the cardiovascular area, unfortunately most of the work has not really produced many results that have gone into clinical practice,” he says. “Overall the literature is pretty confusing out there. Studies have been small, the patient selection has been varied and sometimes biased, most have been retrospective studies and the genetic strategy has not been adequate.”
However, things are changing. As Dr Pirmohamed explains: “There are two drugs out there – warfarin and clopidogrel – where there is an enormous amount of evidence accumulating on the role of genetic factors in determining viability in response.”
“But as we move forward, we need to be able to see how we continue using the old drugs like warfarin, using personalisation methods, and then stratify them with the new drugs as well.”