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March 22, 2017
Imagine if before taking a medication, you could walk into your local pharmacy and take a test that could accurately predict whether the medication would work for you and the dosage best suited to you—all based on your DNA.
This is the genesis behind a BC-based research project “Genomics for Precision Drug Therapy in the Community Pharmacy”, the first of its kind in North America. The project, now entering its second phase, is co-funded by Genome BC and the BC Pharmacy Association (BCPhA), with research led by a team at the University of British Columbia’s Sequencing and Bioinformatics Consortium (SBC).
Testing a person’s genome can predict how they will respond to certain medications—if the medications are effective and if dosages need changing. This type of testing, called pharmacogenomic (PGx) testing, has historically been done mostly in research settings and for limited types of medications. In this research phase, the project will analyze the DNA of patients taking mental health medications to optimize the type of medication and dosage.
The first phase of the project focused on whether pharmacists, no matter if they were in urban or rural communities, could be the conduit to providing PGx testing. That phase determined pharmacists could successfully play this role.
In the second phase, which begins this spring, community pharmacists in a number of communities across BC will focus on recruiting patients who are currently taking mental health medications. Testing will also be applied for patients on other commonly prescribed medications, such as cardiovascular and pain medications. Once a patient’s DNA has been sequenced, the pharmacist will provide a consultation and report back to the patient, and inform their health-care provider as required to help guide drug therapy decisions.
“This is about moving the work out of the lab and giving patients actionable results that can change their lives,” says lead researcher Dr. Corey Nislow, director at UBC’s SBC.
In the first phase of the project, 29 community pharmacists in locations across British Columbia—from greater Vancouver to small communities like Chetwynd—participated and recruited 200 patients. The project focused on patient education, developing and implementing standard operating procedures, and collecting samples from patients in their communities.
“Bringing this type of testing to patients to help them know if a medication works is exactly what pharmacists are trained to do,” says Geraldine Vance, CEO of the BCPhA. “Each day community pharmacists are assessing whether medications work for patients. This is just another tool in the toolbox.”
Genome BC’s User Partnership Program is about improving translation of research innovations into products, services, policy, and practices, says Dr. Catalina Lopez-Correa, Genome BC’s Chief Scientific Officer and Vice President, Sector Development.
“This initiative is a perfect example of collaboration between end users and translational researchers working toward bringing those innovations into communities where people will benefit,” she says.
February 15, 2017
In November 2013, the BC Pharmacy Association (BCPhA) Board of Directors committed to explore the potential to offer pharmacogenomics testing (PGx testing) in community pharmacies. Consistent with the Association’s mandate, the decision was taken to determine whether community pharmacies could be the natural conduit to making this valuable information available to patients.
Since then, the BCPhA has undertaken many activities to advance a commercial launch of a service that would be accessible to Canadians in communities big and small. The primary objective has always been to position community pharmacies as the first and best place for the testing to be offered to the millions of patients taking the most often prescribed medications.
In the first phase of our research project, the BCPhA has worked in partnership with the University of British Columbia (UBC) and Genome BC to develop standard operating protocols to ensure this service can be delivered in a variety of pharmacy environments. We determined that indeed PGx testing can be delivered in pharmacies both in urban and rural areas. As part of our work, we have also undertaken significant stakeholder engagement talking with prescribers, benefit providers, regulators and pharmacy owners about the potential to offer PGx testing through pharmacies.
Every step we have taken has made it clear that pharmacists are the obvious professionals to capitalize on the wealth of information PGx testing provides to patients and how best to determine the use of its findings. Every day pharmacists talk with prescribers and patients about the impact of medications on their personal health. Offering PGx testing through community pharmacy adds another layer of information. It is an essential element in delivering on the promise of personal medicine.
On Feb. 9, 2017, the Association announced another step in the process toward making PGx testing widely available to Canadians.
The BCPhA, through its commercial entity, RxOme Pharmacogenomics Canada Inc., has entered into a joint venture agreement with myDNA Life Australia.
myDNA Life Australia was founded in 2007 and has been at the forefront of research into pharmacogenomics in Australia. They offer PGx testing in more than 300 pharmacies in Australia. This experience reinforces the view held by the BCPhA that community pharmacists are best positioned to help patients and their doctors understand the implications that their genetics have on the medications they take.
myDNA and RxOme are currently in discussions with various pharmacy owners who operate nationally and regionally. Work is underway to finalize the many details needed to make the service available in the first half of the year. The testing will be offered to patients on a private pay basis.
The myDNA pharmacy program offers multi-gene panel testing for the most commonly prescribed medications in the areas of pain, mental health, cardiovascular and Proton Pump Inhibitors (PPIs). Also available are mini PGx tests for each therapeutic area. There is also a plan for personalized nutrition and lifestyle reports for areas such as vitamin supplementation, caffeine/alcohol, exercise and diet.
Our objective has always been to generate a new revenue stream for pharmacists and pharmacies. It was never intended that this be a new source of income for the Association. Our role is to facilitate this opportunity for our members.
In the coming weeks, we will continue discussions with pharmacy chains, banners and independent pharmacy owners to talk about the specific offering and the benefits that they and their patients can garner from this new service.
As a separate initiative, we are continuing to seek funding for the second phase of our research project that we are pursuing with UBC. A primary objective of this research is to demonstrate that PGx testing is of value to private and public payers.
The BCPhA Board and staff team are very excited that we can partner with myDNA. Their work in community pharmacy in Australia has genuinely been ground-breaking. Like us, they are committed to the central role community pharmacists will play in exploring the potential PGx testing has for patients and their health.
Catherine from Burnaby, BC was diagnosed with bipolar disorder more than 25 years ago. Like many people with mental illness, she's taken numerous medications to help manage her illness.
Some of her medications had unwanted side effects. She has suffered several small strokes, ischemic episodes, a damaged kidney, night eating, trouble processing thoughts, has fallen many times and once had a concussion.
The science of pharmacogenomics has the opportunity to use her genetics to uncover which drugs and in what dosage work best for her. Community pharmacy in BC aims to bring this science to patients like Catherine, who are on medications that are impacted by their DNA.
Catherine chose to use her community pharmacy as the place to provide her genetic information for research. Listen to her story:
July 21, 2016
The BCPhA will expand its pharmacogenomics project to cities across Canada this fall, thanks to significant funding from Green Shield Canada (GSC). The “Genomics for Precision Drug Therapy in the Community Pharmacy” project examines the potential for community pharmacies to provide DNA-specific medication advice in order to optimize drug therapy outcomes for patients.
GSC is the first funding partner to come on board for the second phase, which is estimated to take 18 months and involve 1,000 patients in several Canadian cities. It will assess participants’ exomes to provide patient-specific information on the appropriateness of their prescribed medications. Phase 2 is also open to the 33 community pharmacies that participated in Phase 1 of the project.
The focus of phase two will be on particular drug categories for mental health, cardiovascular, pain and possibly respiratory (COPD and asthma). BCPhA is still looking for additional financial contributors for the project. This phase will also help determine whether the project is economically viable and if the public would be willing to pay for DNA testing. Among the 1,000 patients to be recruited to provide samples, there will be a mix of sponsored patients who will have the cost covered and non-sponsored patients who will pay about $2,000 for the testing and analysis.
Pharmacists will also be compensated for delivering the service. BCPhA is now looking for community pharmacies to participate in the project.
What is pharmacogenomics?
Pharmacogenomics is the study of how a person's genetic make-up influences how they respond to a drug and helps guide what doses likely work best for therm.
There are more than 150 medications – ranging from mental health to heart disease to cancer and other drugs -- that are impacted by a person’s DNA.
Lori Robinson believes her DNA not only unlocks the secret to better prescriptions, but also more convenient health care.
The 57-year-old Kelowna resident is one of 200 British Columbians who volunteered to have her genome sequenced as part of a first-of-its kind research project that paves the way for determining what medications and in what dose work for them using her local pharmacist. Read the full story here.
About Genomics for Precision Drug Therapy in the Community Pharmacy
"Genomics for Precision Drug Therapy in the Community Pharmacy" is a research project funded by the BC Pharmacy Association (BCPhA) and Genome British Columbia (Genome BC) with research being done by a team at the University of British Columbia’s Faculty of Pharmaceutical Sciences.
This project set out to position the community pharmacist as the health-care provider through which patient genetic information can be acquired, assessed and used to guide drug therapy decisions. Until now, this work had been done almost excluively in cancer agencies or research labs.
Launched in the fall of 2014, the project focused on developing rigourous training, robust standard operating procedures and educational materials for patients. During 2015, 33 community pharmacies - in both rural and urban areas - recruited 200 volunteer patients to provide their saliva samples to be used for pharmacogenomics research.
This project -- the first of its kind in North America -- ultimately aims to bring the science of pharmacogenomics to patients using their community pharmacist.