Asthma prescribing according to Arg16Gly beta-2 genotype: a randomised trial in adolescents.
Eur Respir J
; 58(2)2021 08.
Article
en En
| MEDLINE
| ID: mdl-33479111
ABSTRACT
INTRODUCTION:
The A allele of rs1042713 (Arg16 amino acid) in the ß2-adrenoreceptor is associated with poor response to long-acting ß2-agonist (LABA) in young people with asthma. Our aim was to assess whether the prescribing of second-line controller with LABA or a leukotriene receptor antagonist according to Arg16Gly genotype would result in improvements in Pediatric Asthma-Related Quality of Life Questionnaire (PAQLQ).METHODS:
We performed a pragmatic randomised controlled trial (RCT) via a primary care clinical research network covering England and Scotland. We enrolled participants aged 12-18â years with asthma taking inhaled corticosteroids. 241 participants (mean±sd age 14.7±1.91â years) were randomised (11) to receive personalised care (genotype directed prescribing) or standard guideline care. Following a 4-week run-in participants were followed for 12â months. The primary outcome measure was change in PAQLQ. Asthma control, asthma exacerbation frequency and healthcare utilisation were secondary outcomes.RESULTS:
Genotype-directed prescribing resulted in an improvement in PAQLQ compared to standard care (0.16, 95% CI 0.00-0.31; p=0.049), although this improvement was below the pre-determined clinical threshold of 0.25. The AA genotype was associated with a larger improvement in PAQLQ with personalised versus standard care (0.42, 95% CI 0.02-0.81; p=0.041).CONCLUSION:
This is the first RCT demonstrating that genotype-driven asthma prescribing is associated with a significant improvement in a clinical outcome compared to standard care. Adolescents with the AA homozygous genotype benefited most. The potential role of such ß2-adrenoceptor genotype directed therapy in younger and more severe childhood asthma warrants further exploration.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Asma
/
Antiasmáticos
Tipo de estudio:
Clinical_trials
/
Guideline
/
Qualitative_research
Límite:
Adolescent
/
Child
/
Humans
País/Región como asunto:
Europa
Idioma:
En
Revista:
Eur Respir J
Año:
2021
Tipo del documento:
Article
País de afiliación:
Reino Unido