The Problem with One-Size-Fits-All Medicine
Adverse drug reactions remain a leading cause of hospital admissions worldwide, and Asian populations carry genetic variants that alter drug metabolism in ways that standard dosing guidelines often fail to capture. In Singapore, where nearly one in three adults lives with hypertension or high cholesterol, the stakes of imprecise prescribing are enormous.
The Pre-emptive Pharmacogenomics (PPGx) Clinical Implementation Pilot, funded by PRECISE and coordinated by CRIS Singapore, was designed to tackle this problem head-on.
Scaling PGx Across Seven Institutions
The pilot has already demonstrated the feasibility of scaling pre-emptive PGx testing across seven healthcare institutions, covering more than 2,000 patients. Structured test results are integrated directly into clinical decision support systems, enabling genotype-guided prescribing and real-world prescription changes.
What distinguishes Singapore’s approach is its focus on Asian-specific variants. The SG10K study, a foundational project within the NPM programme, revealed population-specific risks ranging from adverse drug reactions to dosing sensitivities. This means the PGx panels used in Singapore are calibrated to the genetic realities of the local population—not imported wholesale from Western reference standards.
A Psychiatrist’s Perspective
Dr Wan Yi Min, Senior Consultant Psychiatrist at Ng Teng Fong General Hospital, shared a case that illustrates the pilot’s clinical value. A patient with major depressive disorder had been experiencing emotional numbing, excessive drowsiness, and reduced functionality on a standard antidepressant regimen. Rather than cycling through different medications, Dr Wan ordered a PPGx test. The resulting report highlighted genetic factors affecting drug efficacy and side-effect risk. With this information, the dosage and medication were adjusted—and the patient’s condition improved significantly.
This approach, Dr Wan noted, offers clearer and more scalable benefits than the often-misinterpreted concept of “personalised medicine”.
The Infrastructure Behind the Innovation
Success at this scale required more than genetic testing kits. Key enablers included strong clinician leadership, top-down management support, robust informatics infrastructure, and targeted training programmes. The pilot has also laid the foundation for validating Asian-specific PGx variants, positioning Singapore as a regional leader in pharmacogenomic discovery.
What Phase III Will Scale
Building on the PPGx pilot’s success, Phase III of the National Precision Medicine programme—known as SG-INSIGHT—aims to scale pre-emptive pharmacogenomics implementation nationally. The phase will demonstrate large-scale whole genome sequencing clinical utility, starting with pharmacogenomics and expanding to other use cases as evidence emerges.
For patients, the implication is straightforward: fewer medication trials, faster relief, and reduced risk of harmful side effects.
