Integrating pharmacogenomics in three Middle Eastern countries' healthcare (Lebanon, Qatar, and Saudi Arabia)
Creators: name: El Shamieh, Said
name: Fakhoury, Rajaa
name: Fawaz, Mirna
Publisher: name: Zenodo
Year: 2025
Subjects: subject: Pharmacogenomics
subject: FOS: Medical biotechnology
subject: Lebanon
subject: Qatar
subject: Saudi Arabia
subject: Precision medicine

description: Background and Objectives: Pharmacogenomics (PGx) leverages genomic information to tailor drug therapies, enhancing precision medicine. Despite global advancements, its implementation in Lebanon, Qatar, and Saudi Arabia faces unique challenges in clinical integration. This study aimed to investigate PGx attitudes, knowledge implementation, associated challenges, forecast future educational needs, and compare findings across the three countries.

Methods: This cross-sectional study utilized an anonymous, self-administered online survey distributed to healthcare professionals, academics, and clinicians in Lebanon, Qatar, and Saudi Arabia. The survey comprised 18 questions to assess participants' familiarity with PGx, current implementation practices, perceived obstacles, potential integration strategies, and future educational needs.

Results: The survey yielded 337 responses from healthcare professionals across the three countries. Data revealed significant variations in PGx familiarity and educational involvement. Qatar and Saudi Arabia participants were more familiar with PGx compared to Lebanon (83%, 75%, and 67%, respectively). Participation in PGx-related talks was most prevalent in Saudi Arabia (96%), followed by Qatar (53%) and Lebanon (35%). Key challenges identified included test cost and reimbursement, insufficient physician knowledge, and lack of infrastructure. Lebanon reported the highest concern for test costs (16%), compared to the lowest in Saudi Arabia (5%). Despite these challenges, a strong consensus emerged on PGx's potential to improve patient outcomes, with over 86% of respondents in all three countries expressing this belief. Educational interest areas varied by country, with strong interest in PGx for cancer chemotherapy in Saudi Arabia and Lebanon and for diabetes mellitus in Qatar.

Conclusion: This study highlights the significant influence of varied educational backgrounds and infrastructural limitations on PGx implementation across Lebanon, Qatar, and Saudi Arabia. The findings emphasize the need for targeted strategies in each country to address these distinct barriers. Integrating PGx education into healthcare training programs and clinical workflows could unlock PGx's potential to optimize patient care.
description: Funding provided by: Beirut Arab UniversityROR ID: https://ror.org/02jya5567Award Number:
description: Ethical statement and informed consent

Ethical approval for this study was obtained from the institutional review boards of the participating universities: Beirut Arab University (2023-H-0153-HS-R-0545), Qatar University (QU-IRB 1995-E/23), and Alfaisal University (IRB-20270). Informed consent was obtained from all participants online, ensuring their confidentiality and the right to withdraw from the study without any consequences. Participants were informed that all collected data would be anonymous and confidential, with only the principal investigator having access to the data. Completing and submitting the survey was considered an agreement to participate.

Study design

This study utilized a quantitative cross-sectional research design, involving healthcare professionals (pharmacists, nurses, medical laboratory technologists), university academics, and clinicians from Lebanon, Qatar, and Saudi Arabia. Data was collected through a voluntary, anonymous, private survey to gather PGx perspectives from specialists in the three countries. The study was conducted and reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (r 1).

Survey instrument

The survey questions were adapted from the previously published manuscript by Ghaddar et al., with the approval of Pr. Nathalie Zgheib (2). The instrument comprised 18 questions divided into several sections. The first section collected demographic information such as age, gender, country of residence, occupation, and years of experience in clinical practice or research. The second section focused on PGx implementation, examining participants' familiarity with the concept, attendance or presentation of educational talks, and integration of pharmacogenetic testing into their practice or research. The third section explored the obstacles faced in implementing PGx, asking participants to identify the top five obstacles from a provided list. The final section inquired about future considerations, including measures to overcome barriers in PGx implementation, belief in the potential of PGx to improve patient outcomes, interest in learning about pharmacogenomics, and specific topics of interest.

Before launching, the survey was pilot-tested with a small group of healthcare professionals to ensure content clarity and relevance. Based on the pilot test, the survey questions were modified, added, or deleted to improve the content. The pilot responses were not included in the final analysis. The survey items were tailored to country-specific practice norms through consultation with experts from Lebanon and Qatar, where data collection began. For instance, the PGx of pain management was added due to its common testing in Qatari patients.

Data collection

Participants were recruited through purposive sampling, targeting professionals directly or indirectly involved in PGx. PGx opinion leaders or experts in each country were approached personally via direct email or social media and asked to complete and disseminate the survey within their teams. The survey was launched on September 27th, 2023, and data collection ended on December 23rd, 2023, in Lebanon; January 24th, 2024, in Qatar; and June 7th, 2024, in Saudi Arabia. Participants were briefed about the study's aim in the survey's introductory paragraph and directed to respond anonymously through Google Forms. The survey took approximately 4 minutes to complete.

1. Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13(Suppl 1):S31-s4.

2. Ghaddar F, Cascorbi I, Zgheib NK. Clinical implementation of pharmacogenetics: a nonrepresentative explorative survey to participants of WorldPharma 2010. Pharmacogenomics. 2011;12(7):1051-9.