A primary care pharmacogenetic precision medicine pilot based on specific Māori tribal ethical frameworks and principles

Extraction of *CYP2C19* variants from whole genomes correlated with dispensed medicines, within a dynamic consent framework co-designed with a Māori community

This pilot project demonstrates the feasibility of a primary care pharmacogenetic program co-designed with a Māori tribal community, via the Rakeiora platform integrating indigenous ethical frameworks. In 148 Māori participants, extraction of CYP2C19 variants from whole genomes shows 7% poor metabolizers and 11% rapid metabolizers for at least one drug. According to international guidelines, 40% of prescriptions could have benefited from knowledge of the CYP2C19 genotype. The community was supportive while wishing to retain dynamic consent mediated by trusted local figures.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

Beyond the pharmacogenetic figures, the value of this work is methodological: it shows how to build a PGx program that is acceptable and appropriate within an indigenous community, via co-designed dynamic consent. The 40% of potentially actionable prescriptions confirms the relevance of preemptive genotyping even in primary care. A model of equity and data governance transposable to other underrepresented populations.