Phenotypes associated with genes encoding drug targets are predictive of clinical trial side effects

Abstract

Biomedical scientists face major challenges in developing novel drugs for unmet medical needs. Only a small fraction of early drug programs progress to the market, due to safety and efficacy failures, despite extensive efforts to predict drug and target safety as early as possible using a variety of assays in vitro and in preclinical species. In principle, characterizing the effect of natural variation in the genes encoding drug targets should present a powerful alternate approach to predict not only whether a protein will be an effective drug target, but also whether a protein will be an inherently safe drug target, while avoiding the challenges of translating biology from experiments in non-human species. We have embarked on a retrospective analysis, demonstrating for the first time a statistical link between the organ systems involved in genetic syndromes of drug target genes and the organ systems in which side effects are observed clinically. Across 1,819 drugs and 21 organ system phenotype categories analyzed, drug side effects are more likely to occur in organ systems where there is genetic evidence of a link between the drug target and a phenotype involving that organ system, compared to when there is no such genetic evidence (30.0% vs 19.2%; OR = 1.80). Conversely, we find that having genetic evidence of a Mendelian syndrome involving a drug target in which a certain organ system is unaffected decreases the likelihood that side effects will manifest in that organ system, relative to having no informative syndrome (18.5% vs 20.2%; OR = 0.89). We find a relationship between genetics and side effects even when controlling for known confounders such as drug delivery route and indication. We highlight examples where genetics of drug targets could have anticipated side effects observed during clinical trials. This result suggests that human genetic data should be routinely used to predict potential safety issues associated with novel drug targets. This may lead to selection of better targets, appropriate monitoring of putative side effects early in development, reduction of the use of preclinical animal experiments, and ultimately increased success of molecules. Furthermore, deeply phenotyping human knockouts will be critically important to understand the full spectrum of effects that a new drug may elicit.