Precision medicine, which targets the individual rather than offering a one-size-fits-all approach, is sweeping the world and has finally reached SA.
The country's first precision medicine facility, which has opened in Cape Town, analyses how a patient’s genes will affect the safety and effectiveness of medication as well as how safe a particular drug will be in combination with other medicines a person is taking.
The treatment protocol also looks at lifestyle and how this might affect a drug regimen.
Andrew Macleod, medical director of Nova Genetics in Cape Town, told the Sunday Times: “Treatment should be tailored to an individual, or else a patient might find that they have taken what is essentially a placebo, for possibly prolonged periods, if it is not effective — or worse yet, something that is high-risk or dangerous.”
Based partly on genetic data, clinicians can “modify a patient’s treatment plan so that it accomplishes the best therapy with the lowest risks”.
Nova, Macleod said, is the first company in SA to look at genetic factors, lifestyle and all the medicines a patient might be taking to obtain a “far more holistic picture”.
Scientists at Nova’s facility in Pinelands put DNA samples from a patient through a process that can take up to five days. Their equipment identifies all the genes that have known biomarkers — in other words, the ones responsible for a patient's reaction to medication.
“The data is then securely sent to be analysed by a leading pharmacogenetic company abroad. The data is processed and sent back to us and we generate a report from that,” said Macleod.
The “static” report includes which drugs should be avoided, but a live online report allows clinicians to adjust factors to suggest the best regimen for each patient.
“This might mean taking a different drug, changing a dose, or adjusting something in your lifestyle.”
Macleod said the company is in the early stages of getting involved with research in the public health sector in SA. Similar programmes are under way in the National Health Service in the UK and in the Netherlands.
Separately, the South African Medical Research Council and the University of Cape Town have partnered to create the Genomic Medicine Research Unit, which investigates human biodiversity and how genomic variants affect the health of indigenous populations.
“This quest will contribute to a more proactive and preventive approach to health,” according to the SAMRC.
The next step will be at the individual level, in other words, precision medicine.
While pharmacogenetics — the effect of genetic factors on reactions to drugs — is a crucial component of precision medicine, so is next-generation sequencing for cancer treatments.
$66bn: Global revenue of precision medicine industry in 2021
$140bn: Estimated revenue in 2028
— IN NUMBERS
To this end, said Nova human geneticist Nico de Villiers, “we look at the patient for inherited cancers and then we go into the tumour away from the patient and we look at the specific genetic signature of that tumour. This will tell us what treatments the patient is eligible for. By looking at different mutations, we can see what treatments will or won’t work.”
At the moment only about 30% of cancer treatment options are effective, he said, but next-generation sequencing improves that.
According to the Harvard Business Review, the cost of precision medicine is high but its expansion “could have a major impact on outcomes and costs”.
In the long run it could save the money now wasted on giving patients the wrong drugs, and as the technology was more widely implemented costs would come down.
A study in the US on over-65s found a saving of $7,000 (about R110,000) in medical costs over almost three years in patients analysed for precision medicine.
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