Pharmacogenomics in Asia-Pacific: Nalagenetics CEO Levana Sani Offers Insights and Strategies

by Oscar Wu
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The promise of Precision medicine, where treatment decisions are tailored to individual genetic profiles, is steadily becoming a reality in clinical practice. One key pillar in this revolution is pharmacogenomics (PGx), the study of how genetic variations influence drug response. Understanding these variations can optimize medication choices, minimize adverse reactions, and improve patient outcomes.

Nalagenetics, a Singapore-based genetic testing company, is at the forefront of PGx implementation in the Asia-Pacific region. In a recent interview with Levana Sani, CEO of Nalagenetics, she shared her valuable insights into the challenges and opportunities of PGx adoption, particularly in the Asia-Pacific region, and covered Nalagenetics’ strategies for navigating this dynamic landscape.

Overcoming Challenges in PGx: Path to Widespread Adoption and Its Future Potential

While PGx holds immense potential, its widespread implementation faces several hurdles. One major challenge is physician awareness. Many doctors lack sufficient knowledge about PGx testing and its benefits, hindering their ability to recommend it to patients. “It’s very hard for patients to get access to pharmacogenomics testing because of the lowered awareness that they have towards personalized medicine”, as Levana stated. Additionally, the cost of the test itself can be a barrier for both patients and physicians, even when the medication costs might be covered by insurance or government programs. Levana said: “Patients don’t have to pay anything, but the testing itself is not reimbursed. And the test may cost $100 or almost $100.”

Furthermore, PGx testing ideally occurs preemptively to prevent adverse reactions. However, measuring the impact of preventing future events can be challenging, making it difficult to quantify the cost-effectiveness of PGx and convince stakeholders of its value. As she described: “Convincing payers and physicians to utilize PGx for prevention is a challenge. Sometimes, the circumstances would become trial and error. So it’s still a mindset shift that’s required in the past decade.”

Despite these obstacles, several positive trends are driving PGx forward. Advances in technology have significantly reduced the cost of sequencing, making genotyping more accessible. Moreover, increased research on diverse populations is improving our understanding of drug metabolism profiles across ethnicities, ensuring PGx benefits reach a wider audience. Additionally, growing support from pharmaceutical companies, who are incorporating PGx data into drug development processes, further paves the way for broader adoption.

Shaping the Future of PGx: Nalagenetics’ Vision for Collaborative and Targeted Approaches

Nalagenetics believes the future of PGx lies in collaborative efforts across multiple sectors. Sani envisions increased government involvement in implementing PGx, particularly in developing markets where population genomics programs are gaining traction. “We’ve seen a lot of developing markets  implement their own population genomics programs. And we think that governments like Indonesia and Singapore have invested in up to 100,000 patients to be sequenced.” said Levana.

As evidence accumulates on the cost-saving potential of PGx, wider reimbursement by insurance companies is also anticipated. Levana said: “There’s more and more datasets showing that genetic testing can help reduce costs, not only on a patient level but also on a population level.” She continued: “So with the right price of the test and the right follow up action from the doctors, insurance companies can also benefit from reimbursing pharmacogenomics testing.”

Nalagenetics itself takes a targeted approach to PGx testing, primarily focusing on germline chronic conditions, such as cardiovascular, psychiatry, cancer, and pain, which require long-term medication. Levana emphasized: “If you take a drug for a very long time, it’s important for you to get the right prescription in the beginning.” This is where the right medication choice from the outset can have the most significant impact.

About their biomarker selection criteria, Levana listed out three prioritizing considerations: Clinical actionability based on PGx results (evidence-based recommendations or alternatives from regulatory bodies such as FDA), robust scientific data with diverse population representation (level of evidence), and allele frequencies relevant to specific ethnicities.

Nalagenetics utilizes a range of technologies for PGx testing, from their initial qPCR platform to microarrays and both short and long-read sequencing. Their research arm actively investigates various aspects of PGx, including the prevalence of adverse drug reactions and how PGx can mitigate them. They also compare diagnostic yield across platforms, develop implementation models with hospitals and insurance companies, and assess the cost-effectiveness of preemptive PGx testing in different settings.

Levana Sani’s Insightful Guidance on Adopting PGx in Laboratories

As part of the interview, Sani offered valuable advice for laboratories considering PGx adoption, mentioning that exploring different markets and understanding diverse needs is crucial. Besides Nalagenetics’ own software, Sani also encourages collaborations with major technology providers such as Thermo Fisher Scientific, MGIs, Illumina, Agilent, Oxford Nanopore Technologies, and PacBio.

The selection of the platform that best meets the cost, accuracy, and coverage requirements is essential, and the exploration of long-read sequencing promises to be fruitful in the future. “We work with some very well-known companies, but all of them have their own strengths and weaknesses, ranging from price to accuracy to coverage,” emphasized Sani.

Expanding Horizons Beyond PGx into Predictive Genetic Testing

While PGx is Nalagenetics’ core focus, Sani notes their expansion into predictive genetic testing for diseases like breast cancer, Parkinson’s, and cardiovascular disease. Their breast cancer risk prediction algorithm, which combines monogenic, polygenic, and clinical risk, demonstrated an 8-9 fold increase in sensitivity, particularly for diverse populations, highlighting the potential of personalized medicine beyond drug response.

“We showed that our algorithm and testing can actually increase sensitivity of existing risk prediction for breast cancer. For example, using BRCA1 and BRCA2, especially for diverse population genomes.” And this breakthrough was also announced in the 42nd J.P. Morgan Healthcare Conference, one of the largest Conferences among the field.

A Worth Referencing Road Map for Asia Pacific PGx

Levana Sani’s insights provide a clear road map for navigating the landscape of PGx in Asia. Overcoming challenges like physician awareness and test cost through collaborative efforts, strategic partnerships, and government support is key. Nalagenetics’ targeted approach, rigorous research, and commitment to open access position them as one of the leading companies in driving PGx adoption in the region. As technology advances and evidence mounts, the promise of personalized medicine, with PGx at its core, is set to transform healthcare in Asia and beyond.

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