Every day, millions of people are taking medications that will not help them. The drugs currently being prescribed are optimally beneficial to as few as 4% of the population consuming them. The realization that physicians need to take individual variability into account is driving huge interest in ‘precision’ medicine or Personalized medicine. In this time of technological advancements and unprecedented scientific breakthroughs, personalized health care has the ability to look at a patient on an individual basis so as to detect the onset of disease at its earliest stages, and at the same time increase the efficiency of the health care system by improving quality, accessibility, and affordability.
Every person has a unique genome and personalized medicine relies on technologies that confirm a patient’s biology at the molecular level with DNA, RNA, or protein, which ultimately leads to the diagnosis of the disease. Having an individual’s genomic information can be significantly useful for developing drugs. These days, it’s common for physicians to use a trial and error strategy until they find the treatment that is most effective for their patient, whereas with personalized medicine, we can:
- Specifically, formulate a treatment for an individual and have insight into how their body will respond to the drug.
- Use detailed information of the person genotype to decide the treatment prescriptions, which will be more cost-effective and accurate.
- Shift the emphasis in medicine from reaction to prevention.
- Direct the selection of optimal therapy and reduce trial-and-error prescribing.
- Help avoid adverse drug reactions.
- Improve the quality of life.
- Reveal additional or alternative uses for medicines and drug candidates.
- The decrease in the overall cost of health care due to small and fast trials.
Studies that focus on a single person are known as N-of-1 trials, where enough genomic data of an individual is collected. This data provides the blueprint for the production of various proteins in the body that may have an important role in drug development for one of the several reasons, including the following:
- The protein plays a role in breaking down the drug.
- It helps with the absorption or transportation of the drug.
- The protein that is the actual target of the drug.
- It has some role in a series of molecular events triggered by the drug.
When researchers compare the genomes of individuals taking the same drug, they may discover that a set of people who share a certain genetic variation also share a common treatment response, such as:
- A greater risk of side effects
- Severe side effects at relatively low doses
- The need for a higher dose to achieve a therapeutic effect
- No benefit from the treatment
- A greater or more likely benefit from the treatment
- The optimal duration of treatment
In N-of-1 trials, the appropriate crossover designs, in which different interventions are administered to the same person alternately (possibly with ‘wash-out’ periods in between to allow the drugs’ effects to wear off) would also enable experimenters to compare the effect of different drugs in the same person.
Well-designed N-of-1 trials could be useful in the early stages of clinical drug development and for studies investigating the safety and appropriate dosages of drugs. Currently, phase I and II clinical trials usually involve giving different amounts of an FDA-approved drug to a small group of healthy volunteers.
FDA’s (U.S. Food and Drug Administration) role is to ensure the accuracy of genetic tests, many of which are acquired from the next generation sequencing (NGS), that poses novel regulatory issues for FDA. Recognizing these challenges, FDA is working out an optimum regulatory platform, by issuing discussion papers and holding workshops that will encourage innovation while ensuring accuracy. In addition, FDA has created precisionFDA, a community research and development portal that allows testing, piloting, and validating existing and new bioinformatics approaches to NGS process.
There are still various barriers to bringing N-of-1 trials mainstream, such as:
- Regulatory agencies, researchers, and physicians are wary of moving away from classical clinical trials.
- Pharmaceutical companies tend to focus on drugs that are likely to be used by thousands or millions of people.
- Tailoring treatments to patients is costly as there is a lot of work to be done on biomarkers, monitoring devices, study designs and data analysis methods.
The fact remains still that these well-designed trials could save the millions of dollars that are spent on inappropriate interventions, the management and treatment of persistent or recurring diseases, and on conventional phase III trials. And the best part is that the researchers, as well as doctors, are interested in exposing people’s unique characteristics at the molecular level to deduce better alternatives to the already existing treatment procedures. Also, cheap and efficient devices that collect health data are becoming available along with the increasing support of the governments and life-sciences funding bodies worldwide. All we require is a team effort by innovators, entrepreneurs, regulators, payers, and policymakers to overcome the barriers and move personalized medicine forward.