Pharmacogenomics: Why One Dose Doesn't Fit All

In clinical practice, we are trained to prescribe based on diagnosis, weight, and standard dosing guidelines. What that training often leaves out is a fact that has become increasingly clear through genomic research: the same drug, at the same dose, can behave very differently from one patient to the next, and much of that variation is written into our genes.

This is the field of pharmacogenomics, the study of how genetic variation affects a person's response to medication. Some people metabolize certain drugs unusually fast, meaning a standard dose never reaches an effective level. Others metabolize the same drug slowly, putting them at risk of toxicity from a dose that would be perfectly safe for someone else. In both cases, the patient is not the problem. The one-size-fits-all dosing model is.

For African populations specifically, this matters even more than the global literature suggests, because much of the pharmacogenomic research used to write current prescribing guidelines was conducted on populations with far less genetic diversity than exists across Africa. Variants common in Nigerian populations may be underrepresented or entirely absent from the datasets those guidelines are built on.

This is one of the reasons pharmacogenomics sits at the center of Centre-GPMI's research agenda. As we build out our research infrastructure and partnerships, including our recent collaboration with the University of Jos Human Genomics and Bioinformatics Research Laboratory, part of our long-term goal is to help generate the African-specific pharmacogenomic evidence that is currently missing, so that prescribing decisions here can eventually be guided by data that actually reflects the patients being treated.