This paper reviews the current situation in the field of pharmacogenetics/pharmacogenomics (PGx) in Europe. High expectations surrounding the clinical application of PGx remain largely unmet, as only a limited number of such applications have actually reached the market and clinical practice. Thus, the potential impact of PGx-based diagnostics on healthcare and its socio-economic implications are still unclear. With the aim of shedding some light on these uncertainties, the Institute for Prospective Technological Studies (IPTS) of the European Commission’s Joint Research Centre (JRC) has conducted a review of the ‘state of the art’ and a further analysis on the use of pharmacogenetics diagnostics for preventing toxic drug reactions and improving drug efficacy in Europe. The paper presents highlights from the JRC-IPTS studies and discusses possibilities for improving translation of PGx research in Europe by comparing some experiences in the USA. We also illustrate the related barriers for the clinical uptake of PGx in Europe with specific case-studies. Most of the barriers identified extend beyond the European context. This reflects the global problems of scarcity of data demonstrating proven clinical validity or utility and favorable cost-effectiveness studies to support the clinical application of PGx diagnostic tests in the clinical setting. Another key barrier is the lack of incentives for the private sector to invest in the development and licensing of PGx diagnostic tests for improving the safety and efficacy of out-of-patent drugs. It therefore seems that one key aspect where policy can affect the clinical uptake of PGx is via sustaining large-scale industry-academia collaborations for developing and proving the utility of PGx diagnostics.

1.
Evans WE, Relling MV: Moving towards individualized medicine with pharmacogenomics. Nature 2004;429:464–468.
2.
Need AC, Motulsky AG, Goldstein DB: Priorities and standards in pharmacogenetic research. Nat Genet 2005;37:671–681.
3.
Giacomini KM, Krauss RM, Roden DM, Eichelbaum M, Hayden MR, Nakamura Y: When good drugs go bad. Nature 2007;446:975–977.
4.
Roden DM, Altman RB, Benowitz NL, Flockhart DA, Giacomini KM, Johnson JA, Krauss RM, McLeod HL, Ratain MJ, Relling MV, Ring HZ, Shuldiner AR, Weinshilboum RM, Weiss ST; Pharmacogenetics Research Network: Pharmacogenomics: challenges and opportunities. Ann Int Med 2006;145:749–757.
5.
Weinshilboum RM, Wang L: Pharmacogenetics and pharmacogenomics: development, science and translation. Annu Rev Genomics Hum Genet 2006;7:223–245.
6.
Swen JJ, Huizinga TW, Gelderblom H, de Vries EG, Assendelft WJ, Kirchheiner J, Guchelaar HJ: Translating pharmacogenomics: challenges on the road to the clinic. PLoS Med 2007;4:e209.
7.
Abrahams E, Ginsburg GS, Silver M: The Personalized Medicine Coalition: goals and strategies. Am J Pharmacogenomics 2005;5:345–355.
8.
Shabo A: The implications of electronic health record for personalized medicine. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2005;149:251–258.
9.
Sinha G: Electronic health records help recruit trial participants and track drug safety. J Natl Cancer Inst 2008;100:384–385.
10.
Kush RD, Helton E, Rockhold FW, Hardison CD: Electronic health records, medical research, and the Tower of Babel. N Engl J Med 2008;358:1738–1740.
11.
Gurwitz D, Motulsky AG: ‘Drug reactions, enzymes, and biochemical genetics’: 50 years later. Pharmacogenomics 2007;8:1479–1484.
12.
Hopkins MM, Ibarreta D, Gaisser S, Enzing CM, Ryan J, Martin PA, Lewis G, Detmar S, van den Akker-van Marle ME, Hedgecoe AM, Nightingale P, Dreiling M, Hartig KJ, Vullings W, Forde T: Putting pharmacogenetics into practice. Nat Biotechnol 2006;24:403–410.
13.
Zika E, Gurwitz D, Ibarreta D: Pharmacogenetics and pharmacogenomics: state-of-the-art and potential socio-economic impact in the EU. European Commission DG JRC/IPTS, Technical Report EUR 22214 EN, 2006 http://www.biotechnologyireland.com/SITE/UPLOAD/DOCUMENT/pharmacoEU.pdf.
14.
Woelderink A, Ibarreta D, Hopkins MM, Rodriguez-Cerezo E: The current clinical practice of pharmacogenetic testing in Europe: TPMT and HER2 as case studies. Pharmacogenomics J 2006;6:3–7.
15.
Compagni A, Bartoli S, Buehrlen B, Fattore G, Ibarreta D, de Mesa EG: Avoiding adverse drug reactions by pharmacogenetic testing: a systematic review of the economic evidence in the case of TPMT and AZA-induced side effects. Int J Technol Assess Health Care 2008;24:294–302.
16.
Gaisser S: Modelling the arena – actors and processes in genetic testing development, International Conference: Genomics & Society: Setting the Agenda, Amsterdam, April 2008.
17.
Intellectual Property Rights and Diagnostics: the Implications for Pharmacogenomics. Ongoing project 12/2007–12/2008, contracted by European Commission DG JRC, IPTS; within the ETEPS AISBL framework and carried out by Hopkins MM, SPRU Science and Technology Policy Research, University of Sussex, Brighton, UK; Gaisser S, Fraunhofer Institute Systems and Innovation Research, Karlsruhe, Germany; Enzing C, TNO Centre for Technology and Policy Studies, Delft, The Netherlands; Hogarth S, ISS, University of Nottingham, Nottingham, UK.
18.
Gaisser S, Dreiling M, Hartig J, Hopkins M, Ryan J, Ibarreta D: Building effective institutional frameworks to support European pharmacogenetic research: an international empirical analysis. Int J Biotech 2008 (in press).
19.
Giacomini KM, Brett CM, Altman RB, Benowitz NL, Dolan ME, Flockhart DA, Johnson JA, Hayes DF, Klein T, Krauss RM, Kroetz DL, McLeod HL, Nguyen AT, Ratain MJ, Relling MV, Reus V, Roden DM, Schaefer CA, Shuldiner AR, Skaar T, Tantisira K, Tyndale RF, Wang L, Weinshilboum RM, Weiss ST, Zineh I; Pharmacogenetics Research Network: The Pharmacogenetics Research Network: from SNP discovery to clinical drug response. Clin Pharmacol Ther 2007;81:328–345.
20.
Hunter AJ: The Innovative Medicines Initiative: a pre-competitive initiative to enhance the biomedical science base of Europe to expedite the development of new medicines for patients. Drug Discov Today 2008;13:371–373.
21.
Zika E, Schulte In den Bäumen T, Kaye J, Brand A, Ibarreta D: Sample, data use and protection in biobanking in Europe: legal issues. Pharmacogenomics 2008;9:773–781.
22.
Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on the free movement of such data. http://eur-lex.europa.eu/smartapi/cgi/sga_doc?smartapi!celexapi!prod!CELEXnumdoc&lg=en&numdoc=32004L0023&model=guichett.
23.
Gurwitz D, Lunshof JE, Altman RB: A call for the creation of personalized medicine databases. Nat Rev Drug Discov 2006;5:23–26.
24.
Shabo A: Clinical genomics data standards for pharmacogenetics and pharmacogenomics. Pharmacogenomics 2006;7:247–253.
25.
Nicholas Timmins Relapse for IT records system, The Financial Times, http://www.ft.com/cms/s/0/7b9d569e-2db3-11dd-b92a-000077b07658.html (accessed December 01, 2008).
26.
Gurwitz D, Lunshof JE, Dedoussis G, Flordellis CS, Fuhr U, Kirchheiner J, Licinio J, Llerena A, Manolopoulos VG, Sheffield LJ, Siest G, Torricelli F, Vasiliou V, Wong S: Pharmacogenomics education: International Society of Pharmacogenomics recommendations for medical, pharmaceutical, and health schools deans of education. Pharmacogenomics J 2005;5:221–225.
27.
Gurwitz D, Weizman A, Rehavi M: Education: teaching pharmacogenomics to prepare future physicians and researchers for personalized medicine. Trends Pharmacol Sci 2003;24:122–125.
28.
Frueh FW, Gurwitz D: From pharmacogenetics to personalized medicine: a vital need for educating health professionals and the community. Pharmacogenomics 2004;5:571–579.
29.
Blow N: Genomics: the personal side of genomics. Nature 2007;449:627–630.
30.
van Ommen GB, Cornel MC: Recreational genomics? Dreams and fears on genetic susceptibility screening. Eur J Hum Genet 2008;16:403–404.
31.
Altman RB: PharmGKB: a logical home for knowledge relating genotype to drug response phenotype. Nat Genet 2007;39:426.
32.
Nuffield Council Report: Pharmacogenetics: ethical issues. Nuffield Council on Bioethics, London, 2003.
33.
Cho MK, Illangasekare S, Weaver MA, Leonard DG, Merz JF: Effects of patents and licenses on the provision of clinical genetic testing services. J Mol Diagn 2003;5:3–8.
34.
Hopkins MM, Mahdi S, Patel P, Thomas SM: DNA patenting: the end of an era? Nat Biotechnol 2007;25:185–187.
35.
Barton JH: Emerging patent issues in genomic diagnostics. Nat Biotechnol 2006;24:939–941.
36.
Kaye J, Hawkins N, Taylor J: Patents and translational research in genomics. Nat Biotechnol 2007;25:739–741.
37.
Eisenberg RS: Will pharmacogenomics alter the role of patents in drug development? Pharmacogenomics 2002;3:571–574.
38.
Nilsson LJ, Regnström KJ: Pharmacogenomics in the evaluation of efficacy and adverse events during clinical development of vaccines. Methods Mol Biol 2008;448:469–479.
39.
Ohashi W, Mizushima H, Tanaka H: Economic advantage of pharmacogenomics – clinical trials with genetic information. Stud Health Technol Inform 2008;136:585–590.
40.
van Zimmeren E, Verbeure B, Matthijs G, Van Overwalle G: A clearing house for diagnostic testing: the solution to ensure access to and use of patented genetic inventions? Bull World Health Organ 2006;84:352–359.
41.
Bartlett JM: Pharmacodiagnostic testing in breast cancer: focus on HER2 and trastuzumab therapy. Am J Pharmacogenomics. 2005;5:303–315.
42.
Kroese M, Zimmern RL, Pinder SE: HER2 status in breast cancer – an example of pharmacogenetic testing. J R Soc Med 2007;100:326–329.
43.
Pirmohamed M, James S, Meakin S, Green C, Scott AK, Walley TJ, Farrar K, Park BK, Breckenridge AM: Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients. BMJ 2004;329:15–19.
44.
Dormann H, Neubert A, Criegee-Rieck M, Egger T, Radespiel-Tröger M, Azaz-Livshits T, Levy M, Brune K, Hahn EG: Readmissions and adverse drug reactions in internal medicine: the economic impact. J Intern Med 2004;255:653–663.
45.
Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL: National surveillance of emergency department visits for outpatient adverse drug events. JAMA 2006;296:1858–1866.
46.
Budnitz DS, Shehab N, Kegler SR, Richards CL: Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007;147:755–765.
47.
Lunshof JE, Pirmohamed M, Gurwitz D: Personalized medicine: decades away? Pharmacogenomics 2006;7:237–241.
48.
Phillips KA, van Bebber SL: A systematic review of cost-effectiveness analyses of pharmacogenomic interventions. Pharmacogenomics 2004;5:1139–1149.
49.
Hazell L, Shakir SA: Under-reporting of adverse drug reactions: a systematic review. Drug Saf 2006;29:385–396.
50.
Tengs TO: Cost-effectiveness versus cost-utility analysis of interventions for cancer: does adjusting for health-related quality of life really matter? Value Health 2004;7:70–78.
51.
van den Akker-van Marle ME, Gurwitz D, Detmar S, Enzing CM, Hopkins MM, Gutierrez de Mesa E, Ibarreta D: Cost-effectiveness of pharmacogenomics in clinical practice: a case study of thiopurine methyltransferase genotyping in acute lymphoblastic leukemia in Europe. Pharmacogenomics 2006;7:783–792.
52.
Hogarth S, Liddell K, Ling T, Sanderson S, Zimmern R, Melzer D: Closing the gaps – enhancing the regulation of genetic tests using responsive regulation. Food Drug Law J 2007;62:831–848.
53.
Hogarth S, Melzer D: The IVD Directive and Genetic Testing. Problems and proposals. A briefing presented to the 20th meeting of Competent Authorities, Lisbon, July 2007.
54.
Goodsaid F, Frueh FW: Implementing the US FDA guidance on pharmacogenomic data submissions. Environ Mol Mutagen 2007;48:354–358.
55.
EU (European Commission and EMEA) and FDA Agree on Guiding Principles for Joint FDA EMEA Voluntary Genomic Data Submission Briefing Meetings. FDA press release, May 2006. http://www.fda.gov/bbs/topics/NEWS/2006/NEW01383.html.
56.
Breckenridge A, Lindpaintner K, Lipton P, McLeod H, Rothstein M, Wallace H: Pharmacogenetics: ethical problems and solutions. Nat Rev Genet 2004;5:676–680.
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