Personalising Drug Prescriptions with Precision Medicine

In Singapore, nearly 1 in 10 people1 will react so negatively to a prescription medicine that they will need to be hospitalised for it.

While many factors influence these adverse drug reactions, a person’s genetic make-up undoubtedly play a major role. Some people, for instance, harbour specific gene alterations that let them clear drugs from their bodies more quickly. Others, meanwhile, possess specific forms of a gene that could predispose them to these medicine-associated toxicities2.

Recognizing this, many hospitals now offer genotyping tests to figure out whether a patient is likely to react negatively to a drug or not. However, the vast majority of these tests happen reactively and are given only after doctors have written a prescription, leading to crucial delays in dispensing or adjusting medications. Ultimately, what suffers is patient care.

Rising to usher in a more proactive and pre-emptive pharmacogenomic paradigm to drug response genotyping is a scrappy start-up from Singapore—Nalagenetics.

“Pre-emptive pharmacogenomics testing is an emerging screening method to obtain patient genetic information to personalise prescription or dosing in a timely manner,” explained Levana Sani, BSc, MBA, Nalagenetics’ CEO. “Instead of testing when a patient is sick and about to take the medication, a set of ‘at-risk’ population is tested prior to symptom development or drug requirements.”

A Scrappy Start-up

Founded in 2016, Nalagenetics is the brainchild of four pharmacovigilance experts: Sani, Astrid Irwanto, PhD, its COO, Alexander Lezhava, PhD and Jianjun Liu PhD.

At the time, they were all working under Singapore’s Surveillance and Pharmacogenomics Initiative for Adverse Drug Reactions (SAPhIRE). They were tasked to build a pre-emptive screening panel to test for mutations that might influence drug reactions.

This panel would eventually become Nalagenetics’ first product, but the team also learned one important lesson from the experience: Proper management of genetic information is indispensable to maximizing the value of prevention.

Over the years, Nalagenetics would develop more products and learn more lessons. From a core team of four, the start-up now counts among its roster more than ten advisors and trained consultants. So, too, did support for Nalagenetics grow. In 2018, some two years after launch, Nalagenetics won USD 1 million3 in pre-seed funding, while a Series A financing round earlier this year pumped USD 12.6 million4 into the company.

“We like to think of ourselves as a product/platform company rather than a service company,” said Sani, adding that their different products and platforms fall under three broad pillars, all of which “are designed with cost-effectiveness in mind.”

Precision Medicine for Better Clinical Decision-Making

The cornerstone of Nalagenetics’ offerings are the genetic testing kits, including those designed for COVID-19, drug response-related mutations and personalised nutrition. To go with these tests, Nalagenetics also came up with a genetic interpretation software called the Nala Clinical Decision Support, whose goal is to parse through huge volumes of genetic testing data and come up with personalised, patient-centric clinical recommendations.

To test just how beneficial their integrated and pre-emptive testing approach is, Nalagenetics partnered with a private hospital group in Singapore, encompassing more than 70 general practitioners. Their study seeks to enrol 500 patients who will then undergo genetic testing before being prescribed medicines.

The program will evaluate how quickly drug recommendations can be made, how patients and physicians feel about them and how often they are followed. The study is ongoing. Currently, Nalagenetics has already successfully integrated their system into the hospitals’ electronic health records, providing the participating doctors with actionable information about their patients’ potential drug allergies.

By generating more relevant information about a patient to drive clinical decision-making, Nalagenetics’ work is well-positioned to not only compliment but also bolster Singapore’s sustained push for precision medicine. Indeed, the start-up is working closely with national initiatives to leverage its tests and analytic software to arrive at locally appropriate solutions.

“The close collaboration with Genome Institute of Singapore and National Precision Medicine (PRECISE) sets us apart,” said Sani. “Being able to support these efforts allows us to learn how to scale our solutions and to handle the complexity of the Singaporean context.”

Realizing the Promise of Precision Medicine

Ultimately, however, the point of precision medicine is to improve patient care and outcomes—and Nalagenetics is working on this front, too.

In collaboration with the National University Hospital and the National University of Singapore, the start-up is developing an engagement tool that makes it easy for patients to receive and access their own pharmacogenomic report, as well as contact a doctor.

The digital solution will come in the form of a web portal, through which patients will be asked to create their own account. Their password-protected genetic testing results will be delivered through these accounts, which will also deliver educational content related to the medicines and mutations in question.

Through this initiative, Nalagenetics is setting the stage for greater patient appreciation of and involvement in the country’s precision medicine efforts—and facilitating the smooth integration of proactive genetic testing in routine clinical practice.

References:

1. Chan, S.L., Ang, X., Sani, L.L., Ng, H.Y. Winther, M.D., et al. Prevalence and characteristics of adverse drug reactions at admission to hospital: a prospective observational study. Br J Clin Pharmacol (2016)

2. Wu, X.T., Hu, F.Y., An, D.M., Yan, B. Jiang, X. et al. Association between carbamazepine-induced cutaneous adverse drug reactions and the HLA-B*1502 allele among patients in central China. Epilepsy Behav (2010).

3. East Ventures (November 2018). Nalagenetics Raises Pre-Seed Funding Round Led by East Ventures

4. Francine Ho, The Business Times (March 2022). Biotech startup Nalagenetics raises US$12.6m in Series A funding round