Abstract
Clinical research in high-income countries is increasingly demonstrating the cost- effectiveness of clinical pharmacogenetic (PGx) testing in reducing the incidence of adverse drug reactions and improving overall patient care. Medications are prescribed based on an individual’s genotype (pharmacogenes), which underlies a specific phenotypic drug response. The advent of cost-effective high-throughput genotyping techniques coupled with the existence of Clinical Pharmacogenetics Implementation Consortium (CPIC) dosing guidelines for pharmacogenetic “actionable variants” have increased the clinical applicability of PGx testing. The implementation of clinical PGx testing in sub-Saharan African (SSA) countries can significantly improve health care delivery, considering the high incidence of communicable diseases, the increasing incidence of non-communicable diseases, and the high degree of genetic diversity in these populations. However, the implementation of PGx testing has been sluggish in SSA, prompting this review, the aim of which is to document the existing barriers. These include under-resourced clinical care logistics, a paucity of pharmacogenetics clinical trials, scientific and technical barriers to genotyping pharmacogene variants, and socio-cultural as well as ethical issues regarding health-care stakeholders, among other barriers. Investing in large-scale SSA PGx research and governance, establishing biobanks/bio-databases coupled with clinical electronic health systems, and encouraging the uptake of PGx knowledge by health-care stakeholders, will ensure the successful implementation of pharmacogenetically guided treatment in SSA.
Highlights
Pharmacogenomics is an emergent but highly actionable form of personalised genetic medicine
The clinical utility and cost-effectiveness of PGx testing for improved patient health care is increasingly being demonstrated
This review highlights several challenges that need to be surmounted for the future implementation of routine PGx testing in sub-Saharan African (SSA)
Summary
Pharmacogenomics is an emergent but highly actionable form of personalised genetic medicine. A meta-analysis of GWAS on African cohorts have revealed novel CYP2C9 and VKORCI gene variants with high genome-wide association, in warfarin drug response, leading to subsequent dose adjustments for these cohorts [14] This highlights the benefit and need to identify more African PGx markers through large-scale PGx research for PGx testing in SSA. The advent of cost-effective commercial genotyping microarrays with targeted pharmacogene panels such as the Axiom Precision Medicine Diversity Research Array (Thermo Fisher Scientific, Massachusetts, USA) and other FDA-approved arrays including the Gentris Rapid Genotyping Assay—CYP2C9 and VKORCI (ParagonDx, LLC)—allows for the rapid testing of thousands of pharmacogenetically relevant variants These arrays can be customised to include unique variants of African origin together with simplified bioinformatics workflows.
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