Prescribing based on genetic differences shows benefit in children, teens with asthma
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Personalized medicine with genotype-based prescribing of asthma controller medication led to improvement quality of life for young people with asthma compared with standard care, according to new research.
“Through the human genome project, we’ve found that there are small variations in our gene status and these changes can influence why a medicine will or will not work,” Somnath Mukhopadhyay, MD, chair of pediatrics at Brighton and Sussex Medical School in England, said during a press conference for the virtual European Respiratory Society International Congress. “This is what has led us to test the hypothesis that knowing the gene status beforehand might make us prescribe medicines more effectively.”
Researchers conducted PACT, a randomized controlled trial that enrolled 241 participants aged 12 to 18 years (mean age, 14.7 years) with asthma on inhaled corticosteroids in primary care research networks from the U.K. DNA saliva samples from parents were used to determine the differences in participants’ asthma genetics.
Participants were randomly assigned to personalized care according to variation in the gene encoding for the beta-2 adrenergic receptor at position 16 (rs1042713; n = 121) or standard care according to the British Thoracic Society (n = 120).
Researchers followed participants for 12 months and monitored asthma-related quality of life score change during that time.
Compared with standard care, standardized pediatric asthma quality of life questionnaire score improved by 0.16 (95% CI, 0-0.31; P = .049) for children assigned personalized care. Participants with the homozygous AA genotype (n = 27) had an improved asthma-related quality of life score of 0.42 (95% CI, 0.02-0.813; P = .04).
Moreover, patients assigned personalized care had a lower exacerbation rate compared with standard care from baseline to 12 months (8.3% vs. 15.3%; P = .08). Time to exacerbation was also improved with personalized care (225.7 days vs. 141.5 days; P = .102).
“These results are really promising because it shows for the first time that personalized care showed a significant improvement to standard care and could be beneficial for the treatment of young people’s asthma prescribing in this personalized way,” Tom Ruffles, MD, academic consultant in pediatric respiratory medicine at Royal Alexandra Children’s Hospital in Brighton and Sussex Medical School, said during the press conference.
According to an ERS press release, the approach of personalized care for children and adults with asthma is an important goal for respiratory research.
“The effect was smaller than we expected, and that most likely could be explained by how well controlled the asthma symptoms were for a lot of our children and how actually very few of them had significant symptoms during the follow-up period,” Ruffles said. “Further larger trials are required to focus on those young people with poorer asthma control to really help determine for us what the potential role of personalized care for children with asthma could be.”