DNA-guided prescribing shows major clinical impact in NHS trial
A major NHS study has demonstrated that pharmacogenomic testing can be successfully integrated into routine clinical practice, with genomic data seamlessly incorporated into electronic health records to guide safer prescribing decisions. The PROGRESS programme showed that 95% of patients carried actionable genetic variants related to common medications, leading to prescription adjustments in over a quarter of participants.
Pharmacogenomic testing has moved from laboratory promise to clinical reality, with researchers from the University of Manchester presenting compelling evidence at the European Society of Human Genetics congress in Milan on 27 May that genetic-guided prescribing can be systematically integrated across NHS healthcare settings.
The NHS PROGRESS study, led by Dr John McDermott, NIHR Academic Clinical Lecturer at the University of Manchester, represents a significant advance in personalised medicine implementation. Rather than conducting isolated genetic tests, the programme has developed a comprehensive informatic solution that delivers pharmacogenomic guidance directly within existing electronic health record systems used by GPs and hospital clinicians.
Bridging the clinical implementation gap
The fundamental challenge in pharmacogenomics has not been generating genetic data, but making that information accessible to frontline healthcare professionals in formats that integrate seamlessly with clinical workflows. Unlike rare disease genetics, pharmacogenomic information remains relevant throughout a patient’s lifetime, requiring repeated access across multiple clinical encounters and different healthcare settings.
“Our solution can work with many commonly used genetic testing platforms and all the major electronic healthcare record systems used globally. This means that healthcare professionals need not worry about interpreting genetic reports, instead they receive contextualised guidance within their existing systems as part of the normal workflow,” explained Dr McDermott during his presentation.
The Manchester-based team, supported by the NHS England Genomics Unit and operating within the NHS-England Network of Excellence for Pharmacogenomics & Medicines Optimisation, developed a novel informatic approach that presents genomic data to clinicians without disrupting established clinical practices.
Clinical outcomes demonstrate widespread applicability
The PROGRESS programme recruited participants from 20 sites across England, focusing on commonly prescribed medications including statins, opioids, antidepressants, and proton pump inhibitors. This selection reflects the broad applicability of pharmacogenomic testing across routine clinical practice rather than specialist scenarios.
Interim analysis of the first 500 participants revealed striking results: pharmacogenomic guidance was successfully provided to all patients with a median turnaround time of seven days. Perhaps most significantly, 95% of participants carried a pharmacogenomic result related to their prescribed medications, demonstrating the widespread relevance of genetic variation in drug response.
The clinical impact proved substantial, with just over one in four study participants having their prescriptions adjusted to safer or more effective treatments based on their genetic profiles. This rate of clinical intervention suggests pharmacogenomic testing addresses genuine unmet clinical needs rather than theoretical concerns.
Health economic justification for systematic implementation
The researchers emphasise that large-scale interventions require robust health economic validation. Dr McDermott highlighted existing evidence supporting pharmacogenomic testing, noting recent recommendations from the National Institute for Health and Care Excellence (NICE) for genetic testing to guide antiplatelet therapy following stroke or transient ischaemic attack.
“This was based on a health economic assessment which demonstrated a potential value to the health system of hundreds of millions of pounds in prevented strokes and gained quality of life,” Dr McDermott noted, illustrating the substantial economic potential of targeted genetic testing programmes.
Future research directions and system-wide impact
Having demonstrated successful integration of genomic data into routine care pathways, the research team now plans to leverage routinely collected healthcare data to evaluate broader system impacts. This analysis will examine whether pharmacogenomic-guided prescribing reduces subsequent healthcare utilisation, including follow-up appointments, emergency department attendance, and overall prescribing costs.
The high compliance rate with pharmacogenomic guidance among clinicians particularly impressed researchers. Dr McDermott attributed this success to presenting genetic information similarly to other established biomarkers: “Prescribing is often adjusted based on things like renal function, and so we designed this intervention in a very similar way.”
Endorsement from NHS leadership
Professor Dame Sue Hill, Chief Scientific Officer and Senior Responsible Officer for Genomics at NHS England, emphasised the transformative potential of the approach: “This pioneering study shows how we can transform patient care through innovative approaches to personalised medicine. Seeing that more than a quarter of study participants had their prescriptions adjusted to safer or more effective treatments underscores the real difference this approach can make to people’s lives.”
She confirmed that pharmacogenomics will become a key component of the NHS Genomic Medicine Service, suggesting systematic implementation across the healthcare system.
Professor Alexandre Reymond, Chair of the European Society of Human Genetics congress, highlighted the universal relevance of these findings: “This research concerns us all, since every one of us has a handful of pharmacogenomic actionable variants in our genome. The use of a specific, genomically targeted treatment can greatly reduce the risk of a bad outcome related to these variants.”
The PROGRESS study demonstrates that pharmacogenomic testing has transitioned from experimental intervention to clinically viable healthcare enhancement, with implications extending far beyond the NHS to healthcare systems globally.
