Pharmacogenomics paves the way for personalised treatment

Genetic makeup may be the reason why some medicines function for some people but not others. Pharmacogenomics provides greater insights into targeted and specialised medicine, by combining pharmacology and genomics to study the effects of genomic variation on people’s different responses to medicines.

“Essentially, pharmacogenomics is the study of the genes that might affect how an individual responds to medicine. The study of genomics is well established but was largely limited in the past due to the high cost of gene sequencing technology. So, while it is not a new area, it has been rapidly growing and evolving over the past 10 years or so, as the technology and equipment have become more affordable and accessible,” said Professor Ts Dr Mai Chun Wai, Acting Deputy Director of Research Strategy and Innovation at the Institute for Research, Development and Innovation at IMU University.

Although pharmacogenomics has yet to be gazetted as a medical speciality, international and local organisations have been exploring its huge potential as a gamechanger in medicine. Based on the principles of ‘5 rights’ which are: the right patient, the right drug, the right time, the right dose and the right route, Mai said that pharmacogenomics will change the way healthcare professionals practice medicine. With conventional methods, therapy has been guided by a framework and now, therapy can be guided based on patients’ response, he added.

With prior knowledge of their patients’ genetic makeup, doctors can prescribe medicine with more confidence and provide personalised treatment plans for their patients. Ultimately, personalised treatment plans reduce risks of side effects and patients’ time and costs associated with trying multiple drugs or combinations, and enhance treatment outcomes. As practical applications expand, pharmacogenomics has been impacting areas such as cancer therapy, cardiology, psychiatry, infectious disease and pain management, said Mai.

The local outlook
In Malaysia, community pharmacists and general practitioners have been recommending genetic testing to patients. Genetic testing is likely to become more widely available as interest continues to grow in both private and public sectors. To-date, Malaysia has already seen a stakeholder meeting organised by the National Institutes of Health and the first Malaysia Pharmacogenomics Summit organised in 2024 to facilitate discussions on research, pilot projects in hospitals, development of local guidelines and policies, and training, said Mai.

“At this point, [pharmacogenomics] is a very new field and there is a lot of groundwork to be done before we can apply its use locally,” said Mai. For starters, scientific data that is relevant to the local population is required, as most of the available data is based on Western populations, with limited data on Asian populations, predominantly from China, he added.

Further, access and affordability need to be considered, as genetic sequencing is more costly than a conventional blood test even though the technology is becoming more available. Medical institutions will need to have resources in place to integrate pharmacogenomics into clinical workflows and processes. On a national level, ethical and regulatory frameworks alongside clinical guidelines and protocols are essential to guide its use and applications, and protect patients’ privacy and genetic data to prevent misuse, noted Mai.

Moving forward, he added, paving the way for this new and exciting field will require integration of pharmacogenomics into medical and pharmacy curricula, practical training on interpreting genetic test results and the development of tools to help integrate pharmacogenomics into the prescribing framework, together with continuing professional development. “Over time, with growing education and awareness among healthcare professionals as well as the public, we can look forward to improved application of pharmacogenomics in Malaysia’s medical landscape,” said Mai.