Stroke patients in Tayside are the first in the UK to be offered genetic testing that tailors treatment to individuals.
A simple blood sample provides doctors with the patient’s genetic information that helps clinicians decide which treatment will work best to prevent further strokes and which treatments to avoid as they are less likely to help or may cause side effects.
NHS Tayside is so far the only health board in Scotland to adopt a precision medicine approach, which moves away from one-size-fits-all prescribing to treatments customised to individual patients and their unique genetic make-up.
It is revolutionising treatment in Tayside and will benefit around 600 stroke patients and 400 patients with heart disease each year.
‘Step into the future’
One of the first patients to benefit is Ian Anderson from Perth. The 67-year-old has suffered two strokes in the last five years.
He said: “In January 2017, I took a stroke and the lost the power in my leg and my arm and my speech.
“Then in 2020, they told me I needed a triple heart bypass. When I woke up from that, I couldn’t move my right leg or arm.”
Ian was prescribed clopidogrel, a common treatment to prevent blood clots.
But studies have shown around a quarter of patients don’t benefit from clopidogrel, leaving them at greater risk of further strokes.
Consultant stroke physician Dr Alex Doney said: “Clopidogrel is a widely prescribed medicine which prevents further blood clots from forming.
“Studies have identified that up to 25% of patients will not receive the same benefit from this medication in the first months after a stroke due to the way their body processes it.
“The information contained in the genes can indicate if a patient is in the 25% group and, if so, doctors can select an alternative medication for them.”
Ian, meanwhile, feels privileged to benefit from the pioneering approach.
“It really is a step into the future and one that will benefit patients in the coming months and years,” he said.
“It is quite amazing that a simple blood test can show if my medication is working as effectively as possible and it is reassuring that my medication can be tailored more precisely to me.
“I’ve still got a lot of life to live. I’ve got three grandchildren, I want to get back to them and I’ll do whatever I need to do.”
Clinicians believe this is just the tip of the iceberg, and other conditions could soon benefit from the same precision prescribing.
Dr Doney said: “It’s the first step towards translating clinical research into much wider use of genetic information in everyday healthcare which will help make routinely prescribed medicines more safe and effective for individual patients.
“This is just one drug and one gene that we’re testing. There are an expanding number of medications where we know your genetics are going to influence how well you respond so the number of patients across Scotland who could benefit or indeed across the UK, huge benefits in preventing or reducing the chances of further strokes and heart attacks.”
Professor Grant Archibald, NHS Tayside chief executive, heralded the pioneering work.
He said: “All the members of our acute stroke team in Tayside have worked so hard to bring this new approach to patients across the area.
“It is a perfect example of a whole team of nurses, doctors, pharmacists, scientists and researchers working together to deliver an approach to stroke care which will improve outcomes and provide a truly unique treatment for patients.
“It is a very impressive development in stroke care and one which places Tayside teams right at the vanguard.”