Right drug, right patient, right time

Right drug, right patient, right time

Precision or stratified medicine doesn’t just offer better treatments for patients – it can also help to deliver wider benefits too, both for the health service and for economic development.

Few areas of science can match the excitement that currently exists around precision or stratified medicine. By analysing a patient’s genes – and then studying that genetic information alongside images of their body, the results of blood tests, and other diagnostic tools – clinicians can build up an entire picture about that individual and treat their specific condition instead of following a more general protocol.

For patients, precision medicine can’t come soon enough. At the moment, only about 25 per cent of medicines will work for the people for which they’re prescribed. Clinicians often have to try a series of drugs in sequence or in combination with one another to find the medicine that will work for each individual patient. That process can take months or even years and can take too long for patients with terminal diseases.

“For infection and immunity – and in particular the auto-immune diseases – we now have some remarkably effective therapies that work in a proportion of our patients,” explains Iain McInnes, Muirhead professor of medicine and director of the Institute of Infection, Immunity & Inflammation at the University of Glasgow. “Put simply, precision medicine would allow us to deliver those very effective therapies to such individuals, and at the same time, to very quickly identify people who aren’t going to benefit and go down a different route with them.

“It’s a hackneyed phrase, but it’s about the right medicine for the right patient at the right time. I can’t think of a better way of describing it than that. It’s about the appropriate decision for an individual in the journey through their illness.

“The practice of medicine, particularly in the field of chronic inflammatory diseases, has to some extent been driven by hit-and-miss. We treat according to algorithms and for some people that means there’s a good result but for others we know there will not be a good result for a given treatment – either they will not respond or, worse than that, they’ll have a side effect. So we’re trying to choose the most appropriate inflammatory modifying medicine as early as possible in the patient’s care to prevent future damage and disability.”

If up to 75 per cent of the prescriptions that are currently written for patients aren’t effective, then that poses a huge problem for the National Health Service (NHS) and for the taxpayers who fund it. The NHS in England spends around £15.5 billion each year on drugs, with NHS Scotland buying around £1.1bn. If clinicians could prescribe the right drug for the right patient at the right time then the savings for the public purse would soon mount up.

Inline 01“The challenge for the NHS just now is that the drugs bill is becoming completely unaffordable,” says Carol Clugston, chief operating officer at the College of Medicine, Veterinary & Life Sciences (CMVLS) at the University of Glasgow. “People are living longer, the population is growing, and the drugs that are coming onto the market are incredibly expensive and we can’t afford to pay for them all. If it carries on like this then the NHS will be bust. It’s unaffordable.”

Tailoring specific drugs for specific patients also presents opportunities for pharmaceutical companies too. It currently takes between ten and 15 years to develop a drug and that process can cost in excess of £1.2bn.  As patents on blockbuster drugs expire, pharmaceutical firms are under increasing pressure from their shareholders to deliver results. Many of the drugs they try to produce fall at hurdles during the development process and so if companies can produce more targeted medicines that they know will work for specific patients then they can save both time and money.

Precision medicine can also offer wider economic development opportunities. Studying the genes of patients generates vast amounts of data, which then require smart software to carry out analysis and identify which treatment will suit the individual’s genetic makeup.

Developing the software to power precision medicine – alongside the new drugs, therapies and devices that could be used to treat patients – creates opportunities for both established businesses and start-up companies, including university spin-outs. The University of Glasgow has provided incubator space within its Queen Elizabeth Learning & Teaching Centre (QELTC) at the new Queen Elizabeth University Hospital (QEUH) to help precision medicine companies to turn their ideas into reality.

The incubator sits next to the Stratified Medicine Scotland Innovation Centre (SMS-IC), a Scotland-wide partnership that brings together NHS Scotland, four universities and two companies, Aridhia and Thermo Fisher Scientific. Further industrial space is also available in the neighbouring Imaging Centre of Excellence (ICE), which is being built to house Scotland’s first seven Tesla magnetic resonance imaging (MRI) scanner and other cutting-edge technology, highlighting the role that imaging has to play.

“The promise of precision medicine is to move away from the one-size-fits-all therapeutic model and towards stratifying a patient population in a more precise configuration according to the likelihood of them responding well to treatment,” explains David Sibbald, who is executive chairman of Aridhia and chair of the SMS-IC.

“Cancer is an important area of focus, but the same approach applies to areas such as neurodegenerative diseases – including Alzheimer’s, dementia and multiple sclerosis – and inflammatory diseases like rheumatoid arthritis. One of the opportunities for industry is to help extract knowledge from all of the data generated by these new techniques, such as sequencing DNA or RNA, our buildings block as humans. That generates a vast amount of data that needs to be interpreted into something useful for each individual patient and each individual disease.

“Enormous amounts of data are also generated by advanced imaging techniques, which are particularly important for areas such as Alzheimer’s, dementia and multiple sclerosis. Companies can create products and services that optimise the data management and the analytics around those data sets.”

Sibbald co-founded communications software company Atlantech Technologies in 1992 and sold the business to American networks giant Cisco in 2000. He launched Aridhia in 2008 alongside Andrew Morris, professor of medicine at the University of Edinburgh.

“Precision medicine will turn healthcare into a very informatics-intensive industry, which we’re pretty familiar with in manufacturing, high tech and financial services, which many of us engage with during our daily lives,” he says. “In the longer-term, that could create opportunities for individuals to have access to their own data and for companies to help link it with some of the wearable technology now available, measuring people’s blood pressure, blood sugar and how many steps they’re taking each day.

“At the moment, it’s very difficult for people to engage with the health system in the same way as you would engage with your bank. Health is the most important thing we’re interested in, but we’re disconnected from it at the moment.”

The Scottish Government has signalled its commitment to stratified medicine by unveiling £4 million of funding over the next five years to create a precision medicine ecosystem that will coordinate resources and opportunities throughout the country. The investment was announced by First Minister Nicola Sturgeon during her visit to the SMS-IC in February. [2016]

The University of Glasgow is also leading the training of the next generation of scientists to work in precision medicine across academia, the health service and industry. It runs an award-winning, pan-Scottish postgraduate master of science degree in stratified medicine and pharmacological innovation. Five Scottish universities contribute to the teaching, and students can choose to be based at either Glasgow or in Aberdeen.

That speciality in precision medicine has also been recognised at a UK level. To mark the Queen’s 90th birthday in June, [2016] the UK Government created Regius professorships at 12 of the country’s top universities.

“In the past, the monarch used to award Regius professorships,” explains Dame Anna Dominiczak, Regius professor of medicine at the University of Glasgow.

“Our university has had more than its fair share in the past. But there weren’t any awarded for many years. The tradition was revived for the Queen’s diamond jubilee in 2012 and again this year.