The human body is marvellously complex and so is the science of treatment. Today, the field of medicine has become ever more targeted and specialised, with pharmacogenomics providing greater insights into therapy than ever before.
It comprises three parts, with pharmaco- referring to medicines and how they work on the body; –gen- which refers to an individual’s genetic makeup; and -omics which is to study all the genes on a comprehensive scale.
“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 Prof Ts Dr Mai Chun Wai, Deputy Director at the Institute for Research, Development and Innovation (IRDI), IMU University.
While pharmacogenomics is not yet a gazetted medical speciality, international and local bodies are already looking into its vast potential as a gamechanger in medicine.
At present, any medical professional may pursue their interest and further study in this area, and pharmacists in particular are well-placed to delve into pharmacogenomics, owing to their training in how medicines work and how people respond to them.
“With their comprehensive training in medication, pharmacists can interpret genetic test results that guide the use of medicine; tailor medication regimes based on a patient’s genomic findings, advise doctors on the right medications and dosage for each patient and help patients to understand that their test results mean,” said Prof Mai, who is also a fully registered pharmacist.
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, he said “Pharmacogenomics will change the way healthcare professionals practice medicine. With conventional methods, therapy is guided by a framework; now, therapy can be guided based on what patients will respond to.”
“With prior knowledge of their patients’ genetic makeup, doctors can prescribe medicine with more confidence, tailoring treatment plans that are more suitable for their patients. This reduces the likelihood of side effects, saves time and expense for the patient in trying different drug or drug combinations, and improves outcomes by ensuring they receive the medications that work best for them, based on their genetic makeup,” explained Prof Mai.
As practical applications continue to grow, pharmacogenomics is already making waves internationally, in areas such as cancer therapy, cardiology, psychiatry, infectious disease and pain management.
In Malaysia, some community pharmacists and general practitioners already recommend genetic testing to their customers, followed by blood drawn and sent to a laboratory that provides genetic sequencing.
These services are likely to become more widely available as interest continues to grow among 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.
“At this point, this is a very new field and there is a lot of groundwork to be done before we can apply its use locally,” said Prof Mai. “For instance, we need to first build our body of scientific data that is relevant to our population as most of the available data is based on Western populations, with limited Asian data coming from China.”
“Other considerations are access and affordability, as genetic sequencing comes with a higher cost; while the technology is becoming more available, it still costs more than a conventional blood test. In addition, 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.”
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.
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