UC San Francisco will be first hospital in California to offer pharmacogenetic testing

Beginning May 9, UC San Francisco will be the first hospital in California, and one of only a few nationwide, to offer pharmacogenetic testing. The test will provide critical clues about a patient's unique genetic makeup, enabling pharmacists to tailor medications and dosages accordingly.

The service will result in smarter prescribing and improved clinical outcomes, said Bani Tamraz, PharmD, PhD, associate professor in the Department of Clinical Pharmacy at the UCSF School of Pharmacy and lead of the pharmacogenomics program. A patient's blood will be tested for 15 genes involved in the metabolism of 56 medications, including those that treat cancer, transplantation, pain, heart conditions, infectious diseases, depression and other conditions.

"Adverse drug reactions cause an estimated 100,000 deaths each year – the fourth leading cause of death in the United States – as well as two million hospitalizations. With pharmacogenomic testing, adverse drug reactions can be reduced by up to 30%," Tamraz said.

"Pharmacogenomics will be part of the clinical information our pharmacists will now be able to use to ensure patients receive the most effective medication, and to determine the precise dose," said program co-lead Lisa Kroon, PharmD, chair of the UCSF Department of Clinical Pharmacy, and assistant chief pharmacy officer, clinical innovation, education and research.

"We also want to ensure equitable access to pharmacogenomic testing and this is something we'll be tracking," she said.

More than 90% of the population is believed to carry at least one genetic variant that would prompt a change in a medication or dosing of certain widely prescribed drugs.

"With pharmacogenomic testing, medication is tailored to an individual's genetic makeup, improving efficacy," said Aleksandar Rajkovich, MD, PhD, UCSF chief genomics officer and program co-lead.

Vision is to deliver on 'promise of precision medicine'

"Bringing the latest science into clinical practice is one of the hallmarks of UCSF Health," added Russ Cucina, UCSF vice president of Genetic and Genomic Services and program co-lead. "Our vision is to deliver on the promise of precision medicine for all patients we and our partners serve."

Testing will entail a single blood draw that will identify variations in 15 genes that impact dosing, effectiveness and potential side effects of the 56 medications. The variations can result in adverse drug reactions or indicate a different dosage or alternative medications should be considered.

If patients agree to the testing, UCSF will bill their insurance and post results within two weeks via the MyChart portal. The results will remain in patients' medical records to guide future prescribing. As UCSF pharmacogenetic testing progresses, more genes and medications will be added. Eventually, cheek swabbing may be introduced as an alternative to blood draws.

Weight, age, gender, other drugs influence prescribing

While a patient's pharmacogenetic profile is not the only information needed for smart prescribing – age, gender, weight, drug interactions, pregnancy and smoking status are other factors – it may be the most important. "You're not going to double the dose if someone is a certain age, but if you have genetic variants that show you're a rapid metabolizer, you might do just that," said Tamraz, who has testified in Sacramento in support of a bill to provide Medi-Cal coverage for the testing. The bill passed the Assembly Health Committee and it is expected to be in front of the governor later this year.

For years, we and others have conducted research in which we've identified variants that underlie inter-individual differences in drug response. Yet the results of that research have resided exclusively in scientific and clinical journals. With the opening of the pharmacogenomics program, the research will benefit our patients.

We know one reason for poor outcomes in minority populations is that they are underrepresented in clinical trials. The new program will include major genetic variants found in all populations, allowing all of us to benefit and reducing disparities in outcomes."

Kathy Giacomini, PhD, BSPharm, Dean of the USCF School of Pharmacy