Expert: Overcoming Barriers and Advancing Pharmacogenetics in Clinical Practice

In an interview with Pharmacy Times®, Issam Hamadeh, PharmD, BCPS, BCOP, multiple myeloma clinical pharmacy specialist at Memorial Sloan Kettering, highlighted education as one of the biggest barriers to widespread adoption of pharmacogenetics, as many clinicians lack training to interpret and apply test results in patient care. He noted effective strategies for sustaining pharmacogenetic programs, including continuously updating clinical decision support systems and demonstrating improved patient outcomes to stakeholders. Hamadeh emphasized that pharmacists, as drug experts with strong knowledge of pharmacokinetics, are uniquely positioned to lead the integration of pharmacogenetics into routine care and provide dosing recommendations informed by genetic data.

Pharmacy Times: What do you see as the primary challenges or barriers preventing widespread adoption of pharmacogenetics in everyday clinical practice?

Issam Hamadeh, PharmD, BCPS, BCOP: There have been many studies looking at this to identify the barriers. One of the main barriers that always comes to the top of the list is education. Pharmacogenomics and pharmacogenetics, in general, are relatively new disciplines, and not everyone is trained in them. This is one of the reasons why they haven’t been widely adopted across different institutions. Clinicians who care for these patients often receive pharmacogenetics results but don’t know how to interpret them or use them to inform therapy, dose selection, or any other treatment decisions. This lack of knowledge has been one of the main reasons for the slow adoption of pharmacogenomics.

Pharmacy Times: Are there strategies or frameworks that have proven effective in sustaining pharmacogenetic programs within health care systems?

Hamadeh: There are many good examples and models, and most have already been published. To ensure the sustainability of a program, it is important that it is continuously updated, especially the clinical decision support system. Pharmacogenomics is an emerging field with new data appearing daily, so keeping the system current is essential. It is also important to show stakeholders the outcomes of pharmacogenomics implementation, such as how it improves patient outcomes. Many models demonstrate that incorporating pharmacogenomics into workflow can reduce side effects and improve outcomes in therapy selection. These are the kinds of metrics we need to follow and implement when starting a pharmacogenomics program.

Pharmacy Times: How can pharmacists play a leading role in the implementation and integration of pharmacogenetics into routine patient care?

Hamadeh: Pharmacists have been spearheading this initiative since it was first conceived and implemented in practice. We are viewed as drug experts, and pharmacogenetics guidelines are largely based on polymorphisms in pharmacokinetic genes. Because of our strong understanding of pharmacokinetics, pharmacists are well positioned to interpret these results and make informed decisions. Physicians and other care providers already rely on pharmacists for dosing recommendations, so adding pharmacogenetics is simply an additional layer of complexity to what we already do.