Genomics Could Gain Traction in COVID-19, Other Therapies

 US Pharm. 2020;45(10):2.

A new study examines how pharmacogenomics could improve the safety and effectiveness of COVID-19 drug therapies. Over the past few months, a number of drugs have been under investigation to treat COVID-19 without well-established safety or efficacy data to support these claims. Some of these unproven therapies, however, may have underlying genetic reasons for their ineffectiveness, resulting in fatal adverse effects as found with hydroxychloroquine.

University of Minnesota College of Pharmacy faculty Pamala Jacobson and Melanie Nicol and Pediatric Hematology/Oncology Fellow Takuto Takahashi published a peer-reviewed study in Nature Genomic Medicine about how individualization with pharmacogenomics may improve the efficiency and safety of these medications.

“The application of pharmacogenomic tests can help eliminate fatal hypersensitivity for patients prescribed certain drugs,” said Dr. Jacobson. “We asked the question if selecting a COVID-19 medication or the dose using an individual's genetic information could improve effectiveness or safety.”

“One of the biggest success stories of using pharmacogenomics is with the HIV treatment abacavir,” said Dr. Nicol, “which is now a standard test for potential treatment for those living with HIV and has virtually eliminated fatal hypersensitivity associated with that drug.”

The study looked at a variety of literature sources for COVID-19 drug therapies, including hydroxychloroquine, remdesivir, tocilizumab, and steroids. The researchers found that there are several gene variants that alter how an individual’s body metabolizes and processes COVID-19 therapies and may increase the risk of adverse effects. They also discovered that the risk of taking these therapies is complex, since patients with COVID-19 are usually taking multiple other medications and have underlying conditions that affect the drug. Finally, the scientists found the data for the pharmacogenomics on COVID-19 are limited due to the early stages of the clinical trials investigating treatments.

“While we did not find direct evidence to support use of pharmacogenomic testing for COVID-19, we did identify many actionable genetic markers that may have promise to improve efficacy and safety,” said Dr. Jacobson. “Clinical studies in patients with COVID-19 are needed before routine testing can be recommended.”

In this month’s continuing education lesson (page 34), Donna M. Lisi, PharmD, BCPS, BCACP, BCGP, BCPP, examines the emerging scientific field of epigenetics, which encompasses the study of heritable changes that are caused by the activation and deactivation of genes without any change in the organism’s underlying DNA sequence. Although the genome is relatively stable, epigenetics can alter disease expression and occurrence throughout the life span, which can affect drug therapy.