New £3m research programme to reduce medicine-related harm in older people

Southampton researchers will study whether genetic testing can help identify the safest and most effective medicines for older people taking several regular prescriptions.

The PRIMO programme has been awarded around £3 million in funding from the National Institute for Health and Care Research (NIHR). It will explore how genetic information could be used as part of routine medication reviews.

The aim is to help doctors and pharmacists identify the safest and most effective medicines for individual patients.

The research will be led by Professor Diana Baralle, Co-director Designate at the NIHR Biomedical Research Centre: Southampton, and Dr Kinda Ibrahim, Associate Professor at the University of Southampton.

A growing challenge for older people

As people get older, many develop multiple long-term health conditions. These can require treatment with many different medicines.

These drugs are often necessary. However, taking multiple medicines can increase the risk of adverse drug interactions.

Taking five or more regular medicines is known as polypharmacy. This affects around one-third of adults aged 65 and over.

Adverse drug reactions account for a significant proportion of hospital admissions. They are estimated to cost the NHS around £2 billion each year.

Older people and those living in more deprived communities are particularly affected.

Using genetics to personalise prescribing

Structured Medication Reviews are now a key part of NHS policy. They help patients and healthcare professionals regularly review prescribed medicines.

However, these reviews do not routinely take account of genetic differences. These can affect how people respond to medicines.

One potential way to address these challenges is through pharmacogenomics. This examines how genetic differences can affect a person’s response to medicines.

Pharmacogenomics uses genetic information to help guide prescribing decisions. It can also help tailor treatments to individual patients.

Over 90 percent of people have at least one genetic variant that could influence prescribing decisions for certain drugs. Research has shown that using pharmacogenomics can reduce medication-related harm. It can also improve treatment outcomes.

Yet there is currently limited evidence on how this approach could work in UK primary care. This is particularly true for older adults taking multiple medicines.

Dr Ibrahim said: “This funding is both timely and transformative. By bringing together leading experts in pharmacogenomics and medicines optimisation, alongside NHS partners, patients and public contributors, we will tackle the major challenge of medicine-related harm in people taking multiple medicines.”

“PRIMO will generate the evidence, tools and implementation strategies needed to support the NHS 10-Year Health Plan and embed pharmacogenomics into routine practice. This will enable safer, more effective and truly personalised prescribing, based on a person’s genetic profile, clinical needs and preferences.”

PRIMO brings together collaborators from the University of Southampton, the University of Oxford and Aston University. It also involves collaborators from the NHS, the Health Innovation Network and Queen Mary Clinical Trials Unit.

The team includes researchers, NHS partners, pharmacists and genomics specialists. It also includes health economists, public contributors and primary care teams. This interdisciplinary team was brought together through Wessex Health Partners (WHP).

WHP also supported the development of the research programme. They did this through a series of workshops to help shape the proposal and research agenda.

Genetic testing at GP practices

Researchers will develop and validate a genetic test. This could help healthcare professionals understand how individual patients are likely to respond to different medicines.

The team will work with NHS laboratories to ensure the test can be used easily within existing NHS systems. This will allow results to be shared easily with GPs and pharmacists. If successful, this could make it easier to adopt the approach more widely across the NHS.

The research will begin with a small study involving 34 patients across four GP practices. It will then expand into a larger trial. This will involve more than 1,000 people aged 65 and over who take five or more regular medicines.

The study will compare standard medication reviews with those informed by patients’ genetic test results. It will involve 30 GP practices in Birmingham and the South West.

Researchers will assess whether genetic information helps healthcare professionals make better prescribing decisions. They will also determine whether it helps reduce medicine-related harm.

The team will examine the impact on side effects. They will assess medication burden, treatment adherence and quality of life. They will also look at the effect on healthcare use and NHS costs.

A dedicated Public Advisory Group will contribute throughout the programme. These members of the public will help to shape the study. They will aso share the results with local communities.

Professor Baralle said: “We are excited to begin work on this new NIHR-funded pharmacogenomics programme.

“It represents an important step towards bringing the benefits of genomic medicine into everyday healthcare.”

Supporting the NHS workforce

Alongside the research, PRIMO will support doctors, pharmacists and other primary care professionals. This will give them the knowledge and confidence to use pharmacogenomics in everyday practice.

The programme will build on the nationally recognised Polypharmacy Action Learning Sets. These were developed and delivered through the Health Innovation Network. The network has already trained more than 1,300 GPs and pharmacists across England.

New training resources will help healthcare professionals interpret pharmacogenomic test results. These will enable them to discuss these results with patients and use them safely during medication reviews.

If successful, PRIMO could provide new evidence to support wider use of pharmacogenomic tests in NHS medication reviews.

This could help reduce avoidable side effects and improve treatment outcomes. It could also enable more personalised prescribing for older people across the NHS.