When guideline-prescribed drugs don’t work on a patient or cause even worse symptoms, the patient is probably enduring an adverse drug reaction (ADR). Usually, the doctor will simply treat the patient on the basis of clinical trial and error, despite not everyone being able to accept the same type of drugs. Often patients lose time and money and become vulnerable to other types of reaction. In the US, ADR is the fourth major cause of death, causing 8% of hospital admissions and losses of up to $60 billion. Between 30% and 70% of ADR cases are related to a patient’s genetic response.
Therefore, a Singapore-based medtech startup, Nalagenetics is promoting a solution through pharmacogenomics—the study of genetic responses to drugs that can reduce the risk of an ADR. By analyzing a patient’s genetics, Nalagenetics will be able to recommend to doctors how their patients would respond to certain types of drugs and advise the safe dosage to prevent an ADR. Thus, the startup aims to reduce cases of ADR while increasing the effectiveness of prescribed dosages.
Nalagenetics was cofounded by a team of scientists who met at the Genome Institute of Singapore. The startup initially was meant only to work on a non-profit project on leprosy in Papua, Indonesia—and not become the established company Nalagenetics is now. The team worked with Indonesia’s Research and Development Body (Litbangkes) at the Ministry of Health, and an NGO called Leprosy Research Initiative back in 2016. They sampled the DNA of the patients and analyzed whether their genetics were suited to treatment with WHO-certified leprosy drug Dapsone, given that its worst adverse reaction could have fatal consequences.
“Over the time the project went so well, we decided that maybe there are other applications for pharmacogenomics that we could also explore beyond very specific medical conditions like leprosy,” shares Levana Sani, or Levi as she prefers to be addressed, cofounder and managing director of Nalagenetics. The company also took part in Harvard’s Venture Incubation Program in early 2018, and Levi was also featured in the 2019 Forbes Indonesia 30 Under 30 list.
Although it is still a small company, Nalagenetics runs a comprehensive and end-to-end medical service. The core of its service is its innovation of a reagent—a substance to read DNA—and software to interpret what drugs the patient is susceptible to and how their DNA will react. Moreover, since one’s DNA never changes, a patient only has to take the test once in their life.
“What may change is the interpretation of your DNA … In the future, there will be many more drugs, and we will understand many more things about your DNA. So, the knowledge that you get from one test will always grow, and we will always keep you updated [about which drug you can and cannot take] as a part of our service offering,” explains Levi.
Currently running on a B2B2C scheme, Nalagenetics works closely with doctors through agreements with hospitals. This is because the decision-making capability rests on the doctors who will prescribe the drugs. However,Levi says, in the future, when the market is riper, the company will market directly to consumers.
Nalagenetics’ end-to-end service helps doctors in patientmanagement as well. It will provide training to doctors who want to order the genetic tests and the aforementioned software from Nalagenetics. After providing a recommendation on the suitable dosage and types of drugs based on the patient’s genetics, it will continue by following-up patients who are taking the personalized medication.
“We think that it is a lot for a small company to do, but at the same time, one cannot go without the other. If we [keep on recommending drugs without] monitoring the patient, we won’t be able to get feedback on our product.”
In other words, the results and monitoring for patients and training for doctors come in one test package, which is priced at only Rp 2 million per genetic test. This price is at least 50% cheaper than that of similar companies or labs. The low price is made possible because Nalagenetics narrows down the scope of the tests to only those issues related to drug response. Having their innovations all designed in-house at the Genome Institute of Singapore also gives them the advantage of full control of the products and designs. Nalagenetics is also aiming to shorten the delivery of test result, from up to five days to only three.
Nalagenetics has been working with MRCCC Siloam and the Psychiatry Department of Dr. Cipto Mangunkusumo National Central General Hospital, but not yet on a commercial basis. Currently, Nalagenetics in Indonesia is still making revenue by conducting studies for research institutes, until it gains sufficient trust from doctors and can raise awareness about the importance of genetics. Right now, it has two ongoing studies on drugs related to schizophrenia and breast cancer, which are expected to be completed by early next year. Meanwhile, the head office in Singapore will be ready for commercial operation in October, when it will launch a new product suite.
Levi says that as Nalagenetics is still running on last November’s $1 million pre-seed funding, led by East Ventures, along with Intudo Ventures and several angel investors. Therefore it is not rushing to raise the next funding, which she wants to use to build its lab. “This is good because actually there are not yet real companies in Indonesia that can create a genetic test, for now. So if we can build that capability, that will be amazing.”
Right now, Litbangkes in Papua is observing whether the leprosy study there can be implemented and made into a guideline to treat the same condition across the nation. Levi is hopeful that Litbangkes will welcome Nalagenetics’ innovation and be willing to fund it to work with the country’s social security administrator for health, BPJS Kesehatan. If so, it will lay the foundation for the first genetic testing and personalization of medicine on such a scale by Indonesia. The study is also on process to be published, and there are plans for it to be expanded to Nepal and India.
“I think that’s why the company is here: because we really believe that genetic testing can be life-saving for everyone, not only for the people who can pay for it. So BPJS Kesehatan is definitely one way to ensure that every single person who needs this has access to it,” says Levi.
According to a study by Market Research Future (MRFR), the global genetic testing market will grow at a CAGR of 9.8% within the 2016-2023 period, from $4.6 billion to over $10 billion. While America is expected to remain the largest market, Asia-Pacific is projected to show the fastest growth, up to a CAGR of 10.1% throughout the period. This is boosted by the region’s vast and rising middle-income class, consumers who are also becoming more conscious about healthier lifestyles.
Genetic testing is not a new practice, even for direct-to-consumer test kits, but the results and service do differ from one to another. In Asia, Hong Kong-based Prenetics has raised $40 million series B funding led by Alibaba Entrepreneurs Fund and Beyond Ventures. It sells testing kits directly to consumers to identify hereditary cancer or nutrition genetics. It partners with large insurance companies like AIA and Prudential to spread healthier lifestyle information to the subscriber, although according to Levi similar partnerships are not feasible yet. This is because the insurance companies here prefer to wait-and-see regarding the new market. However, Levi is optimistic about working with them once more doctors are on board with the company.
“Having that end-to-end service: making sure that we give the doctors support from end-to-end, making sure which test is important for which patient, how to give the right support for the doctor after they get the test; are the reasons why doctors go to us, compared to any other testing company. I think it’s worth it, and so far it’s something that the doctors actually value.”