With chronic diseases on the rise in Asia's ageing societies, significant strain is placed on patients, their families, caregivers and the healthcare system. Novel treatments like gene therapy, paired with a supportive care approach, offer hope and minimise impact on people’s quality of life while helping medicine evolve.
Introduction
As societies in Asia grow older, chronic diseases are becoming more and more prevalent. They place serious strain not only on patients, but also on caregivers and the healthcare system as a whole. Globally, one in five people already suffer some form of chronic illness, according to estimates. It has become a serious burden that continues to grow in Southeast Asia.
In Singapore, one quarter of the population will be 65 and above by the end of this decade. This demographic shift is expected to pose challenges for our medical system. In fact, there is already a substantial increase in the percentage of older adults grappling with three or more chronic diseases, also known as multimorbidity. A 2019 study1 carried out by Duke-NUS Medical School’s Centre for Ageing Research and Education and the Ministry of Health found that comorbidities nearly doubled between 2009 and 2017.
It raises the question how we can make sure that the elderly have acceptable living conditions. More urgently, we have to ask ourselves how we can support those that are already suffering from diseases and need help. How can healthcare organisations work together to enhance their quality of life?
The rise of chronic conditions and impacts
A chronic disease is defined as a long-term medical condition characterised by persistent and often gradual progression. Unlike acute conditions, which have a sudden onset and typically resolve in a short interval of time, chronic diseases linger over an extended period and may last for the duration of a person's life. These conditions often require ongoing medical management, and their effects can significantly impact a person's quality of life.
Common examples of chronic diseases include cardiovascular diseases, such as coronary heart disease and stroke, chronic respiratory diseases, like asthma, diabetes as well as certain types of cancer. These diseases are often influenced by a combination of genetic, environmental and lifestyle factors, and they tend to be major contributors to morbidity, mortality, and healthcare costs worldwide.
Chronic conditions and discomfort can bring along emotional and psychological stress. Most immediately, they result in difficulties carrying out daily activities which can be of a very basic nature, like eating and showering. These problems increase even more after the age of 75. Patients become notably reliant on help for various tasks and functions, subsequently also losing their personal sense of independence.
This can have economic implications for the individual patients and their families as well. An earlier study2 by BMC Health Services Research suggested that the annual cost of multimorbidity in persons aged 60 and above in Singapore had passed US$4 billion, underscoring the considerable economic burden associated with the health issue. With financial implications of an ageing population, accompanied by the cyclical decline in the old-age support ratio – which fell from over 13 working adults for one person above 65 in 1970 to a near 5:1 ratio in 2015 – there exists a further strain on caregivers providing not just actual support, but also financial aid.
There is also a growing risk of disability. Osteoarthritis, the most common form of arthritis and leading cause of disability worldwide3, is an example of a debilitating health condition. The degenerative disease, which is caused by wear and tear in the joint, is afflicting an estimated 300 million patients in Asia Pacific, Middle East and Africa.
As soft tissues within the joint deteriorate, symptoms such as discomfort, swelling, and reduced joint mobility emerge. The discomfort is likely to result in decreased physical activity, potentially leading to muscle weakness and increased strain on the joint. With the progression of these issues, the joint may undergo changes in its normal shape over time. Singapore’s Ministry of Health estimates that more than 40% of the elderly suffer from knee osteoarthritis4, making it one of the main health conditions affecting seniors.
Holistic management of chronic conditions
There is currently no cure for this disease. However, timely treatment paired with a supportive and palliative care approach by a multidisciplinary team of healthcare providers can minimise the impact on people’s quality of life. On top of that, there are already available novel therapies that could offer long term solutions for the chronic discomfort in osteoarthritis.
Treatments include minimally-invasive procedures in orthopaedic surgery, physical therapy, patient education through behavioural or cognitive therapy, and family therapy. There are also biomedical treatments such as gene therapy.
Non-pharmacological approaches like physical therapy and cognitive behavioural therapy have hitherto been widely used. Physical therapy and exercise are fundamental to increase mobility, restore a person’s functionality, and facilitate relief.
Beyond the physical aspect, psychological interventions also have proven capabilities to manage discomfort. The mental health challenges faced by elderly individuals are often overlooked and inadequately addressed, and the associated stigma can deter them from seeking assistance. Cognitive behavioural therapy has yielded statistically significant benefits in reducing discomfort.
Furthermore, patient and caregiver education can help determine appropriate supportive and palliative care tools to improve patient outcomes. Especially for caregivers, there is a lack of clear recommendations and training to help patients manage discomfort. Proper training is then essential to elevate the medical interventions, and improve the quality of life of patients and family caregivers alike.
Enter gene therapy
These days, cell and gene therapy offers a glimmer of hope. This new generation of treatments are positioned to revolutionise healthcare across a range of therapeutic areas previously considered untreatable. Unique from traditional pharmaceutical products, gene therapy is tailored to address the needs of an individual patient, rather than the conventional one-size-fits-all solution. There are likely more than twenty approved gene therapy products now, with over two thousand human gene therapy clinical trials reported around the world, mainly in North America, Europe and Asia, and these numbers are expected to grow in time.
Within the development of osteoarthritis, hereditary factors can play a major part. Gene therapy helps break this cycle by genetically mutating and modifying cells in the joints to stimulate self-healing, equipping them to produce anti-inflammatory molecules internally. It also makes the joints in the human body more resistant to wear and tear, thereby preventing further deterioration.
While not without challenges, gene therapy trials are increasingly exhibiting positive and informative outcomes. Patients, who would otherwise be required to undergo surgery or other arduous procedures, can now opt for a precise and efficient solution for the same, if not better, desired results.
Today, cell and gene therapies have broadened their scope from their initial emphasis on oncology to encompass diverse therapeutic domains, such as ophthalmology, typically for inherited retinal diseases, and neurology to address some of the neurological disorders. In Asia, we see a wave of regulatory approvals of related products, as well as a surge of innovative solutions and technologies, resulting in a transformative impact on the entire pharmaceutical ecosystem.
The gene and cell therapy market in Asia is currently expanding with an annual compound growth rate of more than 40 percent5, outpacing the rest of the world. Its most promising markets are China, Japan, Taiwan, and South Korea. Australia and Singapore, too, are establishing themselves as participants in the field, with numerous companies and research institutions being actively engaged in the development of innovative therapies.
Together with a supportive and palliative care approach, the fast-developing therapies will be able to manage discomfort of patients much better, but also alleviate caregiver burdens, improving the overall well-being of their communities’ altogether. There is a clear need to make healthcare more affordable and available to its population. Collaboration between the government, regulators, and healthcare providers is essential to reduce these healthcare costs and increase access.
As the domain of gene therapy undergoes expansion, the Asia Pacific region is strategically positioned to assume a prominent role in advancing and bringing to market cutting-edge therapies. Bolstered by an already robust governmental support and a burgeoning network of companies and research institutions, the region is prepared to make substantial contributions to the evolution of medicine.
With an array of positive impacts to society, the healthcare industry as a whole would have the ability to grow and improve in tandem. As for cell and gene therapy, its capabilities are presented to significantly improve the lives of patients around the world. So, let’s help those patients to recover some quality of life.
Footnotes:
[1] https://www.duke-nus.edu.sg/docs/librariesprovider3/publications-docs/the-signs-study---ii-report-(revised).pdf?sfvrsn=b391ced0_0
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862090/pdf/12913_2016_Article_1421.pdf
[3] https://www.who.int/news-room/fact-sheets/detail/osteoarthritis
[4] https://ntuchealth.sg/elderly-care/resources/health-and-wellness/understanding-osteoarthritis-knee-symptoms-and-treatments
[5] https://www.dksh.com/global-en/lab-solutions/insights/cell-and-gene-therapy-development-four-asia-markets-to-look-out-for
Raman Singh oversees global pharmaceutical operations at Juniper Biologics. The company focuses on researching, developing, and commercializing novel therapies in oncology, rare diseases, and gene therapy. Under his leadership, Juniper expanded operations in Asia, Middle East, and Africa. Raman also led a US$600m acquisition of TG-C (gene therapy) and acquired oncology treatments for multiple regions.
