When AIG Hospitals tested over 1,500 patients—later expanded to 2,000—taking medications for diabetes, hypertension and ulcers, they that nearly 30 percent were taking drugs unsuitable for their genetic makeup.
Dr Reddy with Dr Challa and Dr Uppaluri
Synopsis: AIG Hospitals has introduced India’s first affordable pharmacogenomic testing, after after discovering that that nearly 30 percent of patients respond poorly to standard prescriptions due to genetic differences, including a key enzyme affecting heart, diabetes, and ulcer medications. The test analyses 120 genes from a small blood sample, producing a lifelong personalised report that guides doctors on which drugs and dosages will work safely and effectively for each patient, bridging the gap between Western textbook prescriptions and Indian genetics.
The cardiac patient had done everything right. He underwent surgery. Took Clopidogrel faithfully after the procedure to prevent stent blockages. Followed every instruction.
Then he suffered a heart attack anyway.
“We often see patients suffer heart attacks even after surgery, despite being on this medication,” Dr D Nageshwar Reddy, Chairman of AIG Hospitals, said. “We now know this happens because, in about 20 percent of Indians, the enzyme required to activate Clopidogrel doesn’t function properly.”
The drug wasn’t working. The patient’s body couldn’t activate it. And until recently, nobody knew to check.
When AIG Hospitals tested over 1,500 patients—later expanded to 2,000—taking medications for diabetes, hypertension and ulcers, they discovered something that challenges decades of medical practice: nearly 30 percent were taking drugs unsuitable for their genetic makeup.
The findings prompted AIG Hospitals to launch India’s first affordable pharmacogenomics test in collaboration with GenepoweRx. For ₹5,000, patients receive a lifelong report showing which medicines work for their body and which don’t.
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The textbook problem
“Traditionally, doctors prescribe medicines based on what’s written in textbooks – one tablet after food, or two tablets a day, and so on,” Dr D Nageshwar Reddy explained. “But this is not the right approach, because every individual metabolises drugs differently. Our bodies have enzymes that either activate or destroy these medicines, and the activity of these enzymes varies from person to person.”
For example, the enzyme CYP2C19 exposes the gap between Western medical data and Indian genetics. In Western populations, the enzyme functions fully. In Indians, it shows little or no activity in nearly 20 percent of the population.
“That means when we apply Western data and prescriptions directly in India, one in five patients may not respond to the medicine at all,” Dr Reddy said.
The problem compounds across drug categories. The same enzyme interacts with anti-ulcer medicines, creating unexpected effects. Drug response depends on genetic makeup and organ health – how liver and kidneys function.
“Until now, no one had systematically studied why this variation occurs, how much it affects drug response, or what medicine and dosage should actually be prescribed for each individual,” Dr Reddy noted.
The study that changed prescriptions
Dr Hima Challa completed clinical rotations in genomics at Harvard Medical School. Dr Kalyan Uppaluri trained in internal medicine at Stanford University. Both had witnessed pharmacogenomic testing at major American institutions—Harvard, Stanford, Mayo Clinic—where the FDA now mandates genetic biomarkers for medications.
“The FDA now mandates that any medication prescribed to a patient should ideally have a genetic biomarker attached to it, because the same drug at the same dose doesn’t work uniformly across individuals,” Dr Challa said. “The era of trial-and-error prescribing is over; it only increases the risk of adverse drug reactions.”
When they approached Dr D Nageshwar Reddy with the concept, he recognised its importance. No hospital in India was conducting such testing.
“We started GenepoweRx in 2019, and Dr Reddy has been our mentor since our early days in medicine,” Dr Challa said. “When we approached him with this idea, he immediately understood its importance – being a truly progressive physician.”
Dr Reddy initiated a study on over 1,500 patients with conditions like diabetes, hypertension and ulcers who were taking multiple medications. The study eventually expanded to 2,000 patients. All underwent pharmacogenomic testing.
“We followed rigorous scientific protocols, similar to those used internationally, and ensured long-term follow-up,” Dr Challa said. “The findings were eye-opening – many commonly prescribed medications simply do not work in a significant section of our population.”
The results revealed that in about 30 percent of patients, standard textbook prescriptions proved unsuitable. Dosages required adjustment – some patients needed higher doses, others needed lower doses.
“This clearly shows that without pharmacogenomic insights, we risk giving the wrong prescriptions,” Dr Reddy said.
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Blood sample to lifelong report
The testing process mirrors routine blood work. Lab staff collect 2 mL of blood. Scientists extract DNA and analyse it using Next Generation Sequencing.
“We use validated sequencing platforms such as Illumina and MGI, which produce a massive amount of data – nearly 5 GB for each patient,” Dr Challa explained. “This DNA data is then analysed for gene–drug interactions based on the latest FDA-approved pharmacogenomic markers.”
The system analyses 120 genes influencing drug metabolism. The analysis covers medications for heart disease, diabetes, cancer, gastrointestinal disorders, neurological and psychiatric illnesses, and pain management.
The process takes about 12 days from sample collection to report delivery.
Each patient receives a personalised booklet listing which medicines work for them, suitable dosages, and drugs to avoid. The report stays valid for life – genetic profiles don’t change.
“From the patient’s perspective, it’s really simple – just give a small blood sample at the lab. Come back after 12 or 13 days to collect your report,” Dr Reddy said. “In the meantime, doctors can issue a temporary prescription if needed. Once the report arrives, we can finalise a more accurate, personalised prescription. The best part is – this test is lifelong. You never need to repeat it.”
The cost breakthrough
Pharmacogenomic testing in the US costs about $1,000 – approximately ₹80,000 to ₹87,000. Making it affordable for Indian patients required extensive work.
“Through extensive optimization, data validation, and quality control, we managed to bring the cost down to ₹5,000 without compromising accuracy,” Dr Challa said.
The operational cost runs between ₹3,000 and ₹4,000 per test. Adding overheads—intellectual inputs, analysis, logistics—brings the total to ₹5,000. With larger scale adoption, the team projects costs could drop to around ₹2,000 or ₹3,000.
“It depends on reagent usage and patient volume. The more patients we test, the lower the per-sample cost becomes,” Dr Challa explained. “Reaching ₹5,000 itself wasn’t easy – standard genomic tests usually cost ₹7,000 or more.”
The test saves money beyond its price. Many patients need smaller medication doses than standard prescriptions provide.
“For example, I’ve seen cases where a patient required only one tablet on alternate days – but because we didn’t know that before, we prescribed it daily,” Dr Reddy said. “With pharmacogenomic insights, we can cut unnecessary medication costs by nearly 50 percent.”
Side effects generate additional expenses. Patients experiencing adverse reactions may require extra treatment or hospitalisation. Personalising doses from the start prevents these outcomes.
Dr Reddy recalled a patient who developed severe hyperthermia during surgery – uncontrollable body temperature spikes. Later testing revealed a gene abnormality making him susceptible to this reaction.
“If we had known beforehand, we could have prevented it – and saved his life,” he said. “So when you think about it, this ₹5,000 test is actually saving lives and long-term medical costs many times over.”
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Integrated into practice
AIG Hospitals now tests every admitted patient and visiting outpatient before writing prescriptions. The pharmacogenomic reports integrate into the hospital’s electronic medical record system.
“Once this data is entered into a patient’s electronic medical record, every time they visit a doctor, their genomic information automatically appears on the screen,” Dr Reddy explained. “So, when a doctor prescribes a medicine, the system instantly indicates whether that drug and dosage are suitable for that particular patient.”
The hospital is integrating artificial intelligence. When doctors type a patient’s name, AI will suggest the right drug and dosage based on their genetic profile.
GenepoweRx’s proprietary SIGMA-ML platform uses advanced algorithms and next-generation sequencing to interpret genetic data and generate physician-friendly reports that appear seamlessly in the EMR system.
“We are excited to partner with AIG Hospitals to bring advanced pharmacogenomic testing into everyday clinical care,” said Dr Kalyan Uppaluri, Managing Director of GenepoweRx. “This will help doctors prescribe safer and more effective medicines for their patients.”
The portable solution
Electronic medical records work in tertiary care centres. Smaller clinics and rural areas often lack such systems.
“Each patient gets a printed booklet that clearly mentions which medicines they can take, the suitable dosages, and other important details,” Dr Reddy said. “So even if someone goes to a remote village, they can show that booklet to their local doctor. It doesn’t require any computer, internet, or EMR access – it’s simple and portable.”
The booklet covers over 120 disease categories. A patient with cardiac issues, ulcers and diabetes can use the same report with different specialists.
In emergencies, patients carry their booklets. ER doctors consult the report and immediately know which medicines and doses are safe and effective for that individual.
“Otherwise, we rely only on textbook guidelines, which may not suit every patient,” Dr Reddy said.
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The polypharmacy trap
Dr Kalyan Uppaluri identified how current practice creates problems.
“When a drug doesn’t work, instead of identifying the cause, we often just add another medication,” he said. “This leads to polypharmacy – patients end up taking multiple drugs unnecessarily, which increases risks and costs.”
Many patients don’t report side effects because they assume symptoms are normal.
“Many patients don’t fully report their side effects to physicians,” Dr Hima Challa said. “They assume certain symptoms are normal. Only when a doctor directly asks or probes further do they mention discomforts. These tests help us uncover the complete picture—how a patient’s body is really responding to the drug—not just what they perceive.”
India’s genetic diversity
India’s genetic variation makes testing essential. Patients from different regions metabolise drugs differently. Even family members show variation.
“There’s a lot of genetic variation across India’s populations – from region to region, even within the same ethnic groups,” Dr D Nageshwar Reddy said. “For instance, certain populations in the Northeast have very different drug metabolism profiles.”
He treated two family members with the same condition. Both responded differently to identical medications. Only after adjusting dosages based on each person’s genetic report did both respond properly.
“Unless they’re identical twins, each person needs their own test,” he said.
The study drew samples from across India. AIG Hospitals, being a tertiary care centre, naturally had patients coming from every region – north, south, east, and west.
“We’ve conducted a landmark study – the largest pharmacogenomic dataset in India,” Dr Challa said. “We analysed data from over 2,000 patients. Typically, genomic studies include around 1,000 samples, but ours was much larger.”
The team also references UK Biobank data, which includes about a million patients with roughly 15 percent Indian representation – the rest being mostly Caucasian.
“While the core genes are the same globally, certain genetic variations differ by ethnicity, which is why Indian-specific data is so important,” Dr Challa explained.
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Who should get tested
“I would recommend that all patients—ideally at an early stage—undergo this test,” Dr D Nageshwar Reddy said. “The reason is simple: it’s not just relevant for the present, but for your entire lifetime. Once done, the test remains valid forever and can guide your treatment every time you’re prescribed a medicine in the future.”
Cost remains a consideration. At minimum, anyone taking medication for more than a month should get tested.
“For short-term issues like fever or diarrhoea, it may not be necessary, but for chronic or long-term conditions, it is extremely useful,” Dr Reddy said.
The test works at any age. Paediatric patients can undergo testing.
“Since our genes remain the same throughout life, the results will stay valid permanently,” Dr Reddy said. “So even paediatric patients can undergo the test – it’s a one-time lifelong report.”
The test isn’t disease-specific. It analyses how bodies process any medicine by studying about 190 genes governing metabolic pathways.
“It’s not for one specific disease,” Dr Reddy explained. “This test can be used for multiple diseases – essentially for any condition where medication is involved. Every drug we take works through specific biochemical pathways, and different medicines use different pathways.”
Dr Challa reinforced the preventive aspect.
“I believe this should become as common as a CBC test – just another part of routine health screening,” she said. “You don’t have to be on any medication to benefit from this test. It’s about building long-term clinical utility for every patient.”
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The blood group comparison
Dr Reddy compared pharmacogenomics to another medical breakthrough that transformed emergency care.
“It’s like knowing your blood group,” he said. “When an accident happens, you don’t want to waste time checking blood type – you already know it, and a transfusion can happen immediately.”
The same principle applies to medications.
“Similarly, once you have your pharmacogenomic profile, doctors can make instant, accurate decisions about which drugs to give, at what dose, and which to avoid,” Dr Reddy explained. “Instead of waiting 12 or 13 days to get results after an adverse reaction, the knowledge is already there. So just like your blood group, this should become a basic part of your health record – something every Indian should have.”
Critical drugs already covered
The test covers commonly used medications that fall under the FDA’s strongest evidence grading – Level 1.
“Many commonly used drugs fall under this category – proton pump inhibitors like pantoprazole, cardiac drugs like clopidogrel, and cholesterol-lowering medications like atorvastatin and rosuvastatin,” Dr Hima Challa said. “This test will especially help the elderly and those on multiple medications, reducing side effects and improving treatment outcomes.”
Some cardiologists have started adopting the test proactively.
“Some of the drugs analysed in our study are critical emergency medications – for instance, clopidogrel, which is used during heart attacks or strokes,” Dr Challa said. “If a patient’s pharmacogenomic data is available beforehand, it can literally save a life. Some cardiologists have already started adopting the test proactively – to make sure, in case of an emergency, they can prescribe the right medicine and avoid complications like bleeding or even sudden cardiac death.”
The five-year vision
Dr Kalyan Uppaluri sees transformation coming fast.
“In the next four to five years, I believe this will become the new normal in medicine,” he said. “AIG Hospitals has taken a pioneering role in leading this change, and I’m proud to be part of a movement that’s setting the foundation for personalised, genomics-driven healthcare in India.”
Smaller nations with limited populations are exploring universal screening.
“Smaller nations with limited populations—like some in the Middle East, including Qatar—are even considering screening their entire population, because it’s affordable and can be integrated into their national health systems,” Dr D Nageshwar Reddy said.
AIG Hospitals is engaging with the Government of India to make pharmacogenomics national policy.
“We are also engaging with the Government of India to make this a national policy,” Dr Reddy said. “If introduced at scale, the cost could be brought down further to around ₹3,000, making personalised treatment accessible to all.”
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The first in India
“For the first time, this concept has been introduced in Indian hospitals, and we are probably among the few hospitals in the world to implement it,” Dr D Nageshwar Reddy said.
The implementation goes beyond offering tests. Every patient admitted to or visiting AIG Hospitals undergoes pharmacogenomic testing before prescriptions are written.
“Now, every patient admitted to or visiting AIG Hospitals undergoes a pharmacogenomic test before any prescription is written,” Dr Reddy said.
The validation process took two years.
“We’ve been validating the test over the past two years, and it’s now fully operational,” Dr Reddy said. “We’ve started implementing it in clinical practice and are educating physicians to use it extensively.”
The testing remains optional – an informed choice. But awareness drives adoption.
“For many people, especially in rural areas, the term ‘pharmacogenomics’ is unfamiliar. They may think it’s just a way to make money,” Dr Reddy said. “That’s why we’re working with journalists and educators – to communicate this concept in simple language. Once people understand that it helps save lives and reduce medicine-related costs, acceptance will grow.”
“One of AIG Hospitals’ core missions has always been to reduce healthcare costs – whether it’s medication, surgery, or hospitalisation,” Dr Reddy said. “By partnering with GenepoweRx, we’ve been able to make pharmacogenomic testing affordable for Indian patients. Globally, such tests cost nearly $1,000—around ₹87,000—but we’ve brought it down to just ₹5,000.”
The priority remains India.
“If the rest of the world learns about this, we’ll likely be flooded with requests. But our priority is India – to make sure Indian patients and the healthcare system benefit first,” Dr Reddy said. “As the numbers increase, we’ll continue working toward lowering costs even further.”
“This is the beginning of a new paradigm in medical practice, where treatment will no longer be based on averages, but on the individual’s unique genetic makeup,” Dr Reddy said.
“What we’re doing now at AIG Hospitals changes that approach completely,” Dr Kalyan Uppaluri added. “For the first time in India—and possibly in all of Asia—pharmacogenomics is being implemented at this scale in clinical practice. This is a truly transformative step.”
The test needs to be done only once in a lifetime, as genetic profiles don’t change. Patients receive a personalised report booklet they can share with any doctor, anywhere, for life – ensuring all future prescriptions are tailored specifically for them.
(Edited by Dese Gowda)
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