Patients should routinely have their whole genetic code read to decide on drug doses, one of the world’s leading experts on personalised medicine says.
Common medicines such as statins, painkillers and blood thinners can have radically different effects that could be predicted by analysing a patient’s DNA, said Gianrico Farrugia, chief executive of the Mayo Clinic in Florida.
Medicine is on the verge of a “seismic shift” where sequencing a patient’s whole genome becomes a routine starting point for treatment, Dr Farrugia said. Babies could have their DNA read at birth to help doctors treat them over the course of their lives, he suggested.
Doctors are increasingly excited about the potential of tailoring treatment to a patient’s genetic code rather than just their symptoms, with many of the latest cancer drugs targeting key mutations that drive the disease.
Trials are under way into deciding treatment based on the DNA profile of patients and their tumour, rather than where in the body it occurs, but genetic analysis is yet to become routine.
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In an interview on a visit to Britain this week, Dr Farrugia urged doctors to “stop treating personalised medicine as special”. He added: “That’s a profound shift that needs to happen in this country if we really want to democratise individual medicine. Otherwise it will remain the domain of the few.”
Mayo patients are now routinely offered genetic analysis as emerging research finds it can help administration even of basic drugs, a process known as pharmacogenomics.
“There are some patients who tell you they take pain medication and it doesn’t work, and some say half a dose knocks them out,” Dr Farrugia said.
He said that the difference was down to genetic variations, About a quarter of patients had genes that mean they process drugs such as codeine very quickly, while others cannot break it down “so it’s like giving them candy”, he said.
With millions of patients urged to take cholesterol-lowering statins to cut their heart-attack risks, concern has centred on the side effects. Dr Farrugia said which individuals would get the most severe muscle pain was “totally predictable” using genetic analysis.
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Currently gene sequencing costs more than £1,000, but Dr Farrugia said that prescribing based on genes was likely to cut costs by reducing side effects and the number of wasted doses.
“We want to get it down to $100. At $100 we think it becomes standard,” he said.