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The company partners with both hospitals and pharma companies to personalize medications
According to the CDC, around 1.3 million emergency department visits each year are due to adverse drug events, and 350,000 patients each year are hospitalized after emergency visits for the same reason. This is an especially big problem with older people, as they typically take more medicines than younger people do. The worst part is that many of these issues could be likely prevented with proper dosing.
Finally, thanks to advances in precision medicine, the notion of the right drugs, at the right dosage, being tailored to each individual patient is becoming more of a reality. That's the idea behind InsightRX, a software platform that leverages patient demographics, physiological characteristics, genomic data, drug concentrations and biomarkers to make sure that patients are getting the proper medication dosage.
"The problem that we’re trying to address here is the problem of treatment failure, resulting from one size fits all treatment approaches," Sirj Goswami, co-founder and CEO of InsightRX, told me in an interview.
"We’re tackling this problem for a few reasons: one is that adverse drug events are one of the top 10 leading causes of death in the developed world and also because between 1980 and 2000, one in five prescription drugs were actually relabeled, or removed from the market for safety reasons resulting from prescribers not choosing the correct dose," he said.
"Medical treatments drugs are typically designed for the average patient, and that’s the problem we’re directly addressing. We tailor treatment by leveraging patient characteristics, genetics and biomarkers to improve patient outcomes and reduce the incidents of adverse drug events."
On Thursday, the company revealed that it raised a $10 million Series A funding led by HealthX Ventures, with participation from Rock Health, OSF Healthcare, Leawood Venture Capital, Premier Inc., and earlier investor GreatPoint Ventures. InsightRX has now raised more than $13 million altogether.
The InsightRX platform
Founded in 2015 out of UCSF, InsightRX has two main products: Nova, which is its precision dosing platform; and Apollo, its integrated clinical analytics platform, providing population level analytics for healthcare systems and pharma/biotech companies.
"The way it works is we have a software platform that integrates with various electronic health record systems, like Epic and Cerner, so the application is directly accessible directly within these EHR systems. Once the application is accessed the relevant data is pooled, we perform the pharmacology simulations and present a dashboard to the end user, typically embedded within the clinical workflow,"Goswami explained.
"Then, within that dashboard, the clinician can assess their current doing guidelines, they can potentially modify the dose and figure out what would be appropriate for an individual patient based on the patient’s own underlying characteristics, demographic and clinical characteristics."
InsightRX operates a two-sided marketplace, he said, with its primary customers being providers on one side and also biotech and pharmaceutical companies on the other.
On the provider side, the company sells its platform and providers buy various drug modules that exist within the platform, covering infectious disease, chemotherapy and immunology. On the biotech and pharma side, the company develops companion applications that augment drugs with precision dosing.
"We work with drug companies to take their mathematical models, we create an application framework around it under a quality management system-type umbrella, and then basically deploy the companion application in a clinical trial with the ultimate goal of embedding the companion application as part of the treatment label," Goswami said.
"That’s the vision that we have. We believe that every complicated drug should be paired with an InsightRX companion application so that the efficacy is maximized and the chances of drug-related toxicity are minimized."
The Nova and Apollo platforms are currently being used by more than a hundred healthcare institutions and life science companies throughout the US and Europe; that includes pilot customers, research institutions that are using the platform for various research studies, and hospitals where InsightRX has commercially launched and it being paid. The company partnered with the Children’s Hospital Los Angeles (CHLA) this past March.
The benefit of precision dosing
The value of the InsightRX varies depending on which side of the marketplace; on the provider side, for example, there are operation efficiency metrics, as well as clinical metrics that they would look at to determine success.
"From a clinical standpoint, if you take, for example, one drug called Vancomycin, what we show from an ROI perspective is the ability to hit the therapeutic target of interest, the drug concentration target, more effectively, and, by doing that, the incidents of acute kidney injury goes down," Goswami said.
"We’ve shown a reduction in acute kidney injury across a variety of healthcare systems that we work with, and that’s powerful because if you reduce the incidents of acute kidney injury, that has a direct impact on cost savings. Each acute kidney injury event associated with Vancomycin administration, there’s a lot of variability in terms of the cost, but that typically results in additional length of stay, potentially other drugs that need to be administered to an individual patient to combat the nephrotoxic event, so there’s a cost burden that we’re mitigating for an individual healthcare system with precision dosing."
On the pharma side, though, the ROI might not be as immediate as it is on the provider side, simply because the drugs are still in the development phase. There could, however, be a lot of benefits once the drug is developed into clinical trials.
"If the clinical trial is actually trying to individualize dosing we create a direct software mechanism to provide that functionality. In addition to that, our software could help a pharma company get to the right answer faster, so getting an understanding of the pharmacological variation, getting an understanding of whether the drug is working or not, earlier on during the drug development process. By getting this information earlier on, through this software mechanism, one can make strategic decisions faster," Goswami explained.
The ultimate benefit, though, especially in an increasingly value-based healthcare model, is actually getting those pharma and biotech companies a seat at the table when it comes to precision medicine.
"These companion applications that we develop in conjunction with these companies will enable that. They will maximize the efficacy of the drugs that they are developing, minimize the chances of drug-related toxicity, and, ideally, we live in a world where every complicated medication has this software construct attached to it. In a value-based care world, the economic incentives will be directly aligned with the clinical need to precisely dose patients."
The changing healthcare space
Precision medicine is a fairly new space; what that means is that the way it's defined might vary depending on who you talk to. Most people, Goswami said, think it means using genetic factors to determine what the right drug is for the right patient, but that's not how InsightRX would define it.
"In reality, precision medicine, or personalized medicine, whatever it is that you want to call it, is a lot wider in scope. It includes using additional information about the patient, not just genetics, other clinical factors, demographic factors. Also, precision medicine isn’t just about selecting the right drug for the right patient, it’s also about getting the right dose as well. So, in that broad category of precision, our angle is precision dosing," he told me.
Beyond just the rise of precision medicine, though, there are a number of things happening in healthcare right now that make the timing just right for InsightRX to potentially take off, one of which has to do with changing dosing guidelines for infectious disease; the Infectious Disease Society of America (IDSA), which will be publishing new guidelines in the next month or two.
"That’s interesting because healthcare systems, once the guidelines come out, will read it and say, ‘I need a software framework that allows me to leverage that functionality to get the right dose for the right patient who’s getting Vancomycin therapy. That tailwind is significant and it’s helped us quote a bit because a lot of healthcare institutions are getting ahead of the guidelines, and they want to talk to us and explore the opportunity of using InsightRX as a potential solution," Goswami said.
In addition, he says that the FDA is becoming more interested in the space as well, and even held a symposium on precision dosing in August, which Goswami spoke at.
"One of the key points that was brought up was pharma involvement, so we need to incorporate precision dosing technology early on in the drug development process. That’s certainly what we’re doing, but it’s also reassuring to hear that the FDA and other major stakeholders in healthcare, such as academics, think that’s a valuable approach," he said.
Despite those positive signs, though, Goswami is fully aware that the company isn't yet close to achieving its goals, and that it's going to be a marathon, not a sprint.
"We have a long way to go, of course, and you have to be humble about this. Healthcare is long, it’s slow, the sales cycle is not trivial, but as long as you’re solving a real pain point, as long as you’re not retrofitting a solution to a problem that doesn’t exist, which a lot of technologies may end up doing, it's just a long game. It will take time but, hopefully, success will eventually be realized."
The future of InsightRX
In the short term, InsightRX plans to use the new funding, in part, to deepen its integration capabilities with its current EHR partners, like Epic and Cerner, and to expand to new EHR vendors, including AllScripts, along with third party integration companies to make the integration process go smoother.
"On the pharma side, it’s very important for us to integrate with electronic data capture systems as well; EDC systems are basically the EHR equivalent for clinical trials. So, we need our platform, our API, need to be able to connect to these types of systems moving forward," said Goswami.
The funding will also go toward the company expanding into new therapeutic areas, beyond infectious disease and chemotherapy, though it will also be adding new products in those areas as well.
"We will continue to round out our product suites in infectious disease and oncology. More specifically in oncology, we will be developing a few very notable products, especially in the neutropenia space. Then, beyond that, we’re going to continue to round out our suite in transplantation medications, immunology, we’re working in IBD and Crohn's disease," said Goswami.
"The other area is solid organ transplant, coagulation medication, so there’s a number of therapeutic areas, as you can probably guess, that stand to benefit from precision dosing. We’re agnostic to the therapeutic area, we’re agnostic to the drug specifically, so if there’s a need clinically to estimate drug exposure, to estimate pharmacological response, we can certainly help the healthcare institution do that. The same holds true for our pharma and biotech clients."
The long term goal for the company is to enable precision dosing on a global scale, and to be the technology solution that enables adoption of that technology.
"To do this, to achieve our vision, our strategy has been to take a two sided approach. On the provider side we will continue to optimize treatment for drugs that have been approved and are commercially available; and on the pharma side our plan is to partner with companies to develop companion applications during the drugs development process for drugs that have not yet been approved, enabling precision dosing to be embedded into the clinical trial and approval process," said Goswami.
The company also has the goal of having a really well-rounded platform that enables precision dosing across a variety of therapeutic and disease areas.
"We want to make sure we expand our presence in both the healthcare system space, hospital provider market, to provide value to patients, for clinicians, but also on the biotech/pharma side to establish a few basic partnerships with notable biotechnology companies and demonstrate, have a proof of concept, around the vision that we have. To work with drug companies during the drug development process, build a companion application and, ultimately, take it all the way through, embedded into the treatment label. That would be, from my perspective, a huge win and really fulfilling my lifelong goal."
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The prevailing 'one-size-fits-all' approach to drug treatment of diverse populations is failing: in the US alone more than half of all prescribed drugs fail due to lack of efficacy or serious side effects. This results in hundreds of thousands of deaths each year, and billions of dollars in costs. Efforts in personalized medicine from healthcare practitioners and/or pharmaceutical companies focus primarily on selecting the right drug for the right patient. Drug dosage is however often overlooked and rarely optimized for the individual patient.
Our InsightRX software platform fills this gap by providing an informed, patient-specific dose by leveraging mathematical models, patient demographics, physiological characteristics, genomic data, drug concentrations and biomarkers. The software platform, mobile app, and API iteratively optimize dosing and treatment strategies, and provide clinically relevant analytics to healthcare practitioners and pharmaceutical companies.
Joined Vator onA Ph.D. candidate (soon to be graduate) at UCSF, with a research focus in genomics, pharmacokinetics and pharmacometrics. I have over four years of industry experience at Genentech and Pfizer in various R&D groups.