Pharmacogenomics in primary care: a quality improvement project at Alconbury and Brampton surgeries 2019-2023.

Abstract

Treatment of depression is common in primary care but not every antidepressant is effective in every patient. Adverse drug reactions are common, imposing a substantial burden on the patient and the NHS. Pharmacogenomics (PGx) utilises an individual's genetic makeup to predict their response to medications. By tailoring prescriptions to a person's genetic profile, PGx can significantly reduce adverse drug reactions, identify non-responders to medications, and enhance overall patient outcomes. To see if PGx testing for antidepressants can be undertaken in general practice as part of 'usual care'; to increase GP and patient awareness of PGx testing; to alter patient treatment according to the results of testing; and to sustain these changes at 4 years. In 2019, 23 patients were recruited by GPs at the surgery. They consented and had cheek swabs to check their genetic profile to common antidepressants. Results were reviewed at 1 week by the GP and patient, treatment changes made and reviewed again at 4 years. On the CYP2D pathway, 19/23 patients were extensive (normal) metabolisers, one intermediate and two poor. These two had their treatments changed. At 4-year review 19/23 were on appropriate treatment (two had been stopped) but two had inappropriate drug treatment. On CYP2C19 pathway, 10/23 were normal metabolisers, eight intermediate, zero poor but five ultrarapid (they had their treatment changed). At 4-year review, 20/23 were on appropriate treatment (two stopped) and one inappropriate. PGx testing works in primary care, improving patient outcomes sustainably.