Drugs are an important element of the research, teaching and service delivery undertaken within the institutions involved in LHP.
1) Personalised Health related initiatives: A central part of the therapeutics theme is to foster research in stratified medicine. In addition, working with the AHSN, we aim to introduce some form of genetic testing into clinical care by working with a diagnostics company
One example is the FUTURE initiative. A project to develop a panel of healthy volunteers who have been genotyped for polymorphisms in drug metabolising enzyme and transporter genes, who can then be readily recruited for Phase I healthy volunteer studies.
2) NW Genomics Healthcare Alliance: To develop a strategy to bring together the enormous expertise that is available within the NW Coast region. This should involve a consolidation of the existing strengths by leveraging this to develop a new model which places the region on the national map as a centre of excellence for clinical care, research and education. In late 2013, LHP established the North West Coast Genomics Healthcare Alliance (NWC GHA), supported by NWC Academic Health Science Network (NWCAHSN). Chaired by Professor Munir Pirmohamed, the Alliance brings together a range of clinical and academic genomics expertise from across the region, to look at the themes of research, education and services. Now looking at building genomics into Masters qualifications at the University of Liverpool, the Alliance will also be involved in several other upcoming bids in 2015.
• NWC GHA was responsible for coordinating the successful bid for the NWC Genomic Medicine Centre led by Liverpool Womens’ Hospital and has established a range of genomics educational workshops for clinicians.
• Liverpool PRiME. LHP has been working with Liverpool Local Enterprise Partnership and NWC AHSN to develop the Liverpool Precision in Medicine Report, produced by Price Waterhouse Coopers. This report aims to bring investment into the region in the area of precision medicine, outlining several projects which are looking for longer term funding.
3) Pharmacovigilance in LHP: Reporting of adverse drug reactions to the MHRA is an important marker of quality of care of patients. There is wide variability in reporting at present. Having convened a working group, LHP aims to improve reporting of adverse drug reactions within LHP Trusts to make the region stand out in improving drug safety. This effort will be linked to improving education and training in this area, and will also involve the prevention of drug-drug interactions. The YCWG is exploring the possibility of holding an annual event in the Mersey region to engage practitioners further. Methods to engage patients and increase patient reporting are also under investigation
• The Yellow Card Working Group (YCWG). Established in May 2014 to improve adverse drug reaction reporting via the Yellow Card Scheme in LHP Trusts. A number of different initiatives and approaches have been adopted with overall reporting up 61% in 2014/15 compared with in 2013/14.
. Liverpool Adverse Drug Reaction Causality Assessment Tool. A project to evaluate the implementation of the tool has been submitted to the CLAHRC North West Coast.
4) Alcohol: Alcohol misuse remains a major cause of morbidity, mortality, hospital admission and social problems within the LHP patch. There are initiatives in the community to reduce the transition from social to problem drinking, and this preventive approach is clearly important. However, for the many patients who have gone beyond this point, and are classed as alcohol dependent, there is a need to better develop how we use drugs that prevent relapse to drinking. Four areas are being targeted: (a) define the pharmacoepidemiology of current drug use by using health informatics databases; (b) develop baclofen as a treatment for alcohol dependent patients with liver impairment; (c) stratify the use of naltrexone in patients by genotyping for the mu-opioid receptor; and (d) identify new biomarkers of hepatic fibrosis/cirrhosis, and identify new drug targets.The LHP Alcohol Research Alliance (LARA) has been established to foster closer working links between alcohol related researchers in the Liverpool region. The group consists of clinicians, specialist nurses, academics and policy makers, with the aim of developing cross theme programmes that will allow a range of translational research questions to be addressed.
• Alcohol Research Biobank. Initial funding has been secured from the Liverpool BRC in Personalised Health. Once established the team will be looking for larger, sustainable funding streams.
•GenomALC. A collaboration has been established with an international consortium (GenomALC) to investigate the relationship between alcohol consumption, genetics and progression to alcoholic liver cirrhosis.
• Alcohol Research UK has funded several Liverpool, and other national , projects to identify how drugs are used in the treatment of alcohol dependence.
5) Cardiovascular pharmacology: Cardiac disease is the major cause of death nationally, and working with 5LHCH, we intend to identify new areas which can be developed that will improve existing drug therapy and improve capability in the region. The warfarin example reflects a project which is far advanced, but other areas which are being discussed include personalised renal function monitoring in patients with heart failure being treated with diuretics and stratification of anti-platelet therapy.