Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
J Natl Med Assoc. 2021 Feb;113(1):8-29. doi: 10.1016/j.jnma.2020.07.001. Epub 2020 Jul 28.
Outcome differences driven by variation in Blacks' biologic response to treatment may contribute to persistent racial disparities in asthma morbidity and mortality. This review assessed systematic variation in β agonist treatment outcomes among Blacks compared to other groups.
We conducted a systematic review of studies reporting differential response to β agonists among Blacks, including studies identifying pharmacogenetic variants.
Of 3158 papers, 20 compared safety or efficacy of β agonists among Blacks as compared with other subgroups. Six papers evaluating efficacy of short-acting β agonists (SABA) found similar or improved results among Blacks compared with other groups, while one small study found reduced response to SABA therapy among Blacks. Reports of safety and efficacy of long-acting β agonists (LABA) indicated similar results among Blacks in four papers, while four reports found reduced safety among Blacks, as compared with other groups. Four papers assessed genomic variation and relative treatment response in Blacks, with two finding significant effects of the p.Arg16Gly variant in ADRB2 on β agonist response and one finding significant gene-gene IL6/IL6R interaction effects on albuterol response.
Evidence suggests the potential for differences in β agonist outcomes among Blacks compared with other groups. This literature, however, remains small and significantly underpowered for substantive conclusions. There are notable opportunities for adequately-powered investigations exploring safety and efficacy of β agonists among Blacks, including pharmacogenomic modifiers of response.
由于黑人对治疗的生物学反应存在差异，可能导致哮喘发病率和死亡率方面持续存在种族差异。本综述评估了黑人与其他群体相比，β 激动剂治疗结果的系统差异。
我们对报告黑人对β激动剂的反应存在差异的研究进行了系统综述，包括确定药物遗传学变异的研究。
在 3158 篇论文中，有 20 篇比较了黑人与其他亚组之间β激动剂的安全性或疗效。6 篇评估短效β激动剂（SABA）疗效的论文发现黑人与其他组相比，结果相似或改善，而一项小型研究发现黑人对 SABA 治疗的反应降低。四项报告指出，黑人使用长效β激动剂（LABA）的安全性和疗效相似，而四项报告发现黑人的安全性降低，与其他组相比。四项论文评估了黑人的基因组变异和相对治疗反应，其中两项发现 ADRB2 上 p.Arg16Gly 变异对β激动剂反应有显著影响，一项发现 IL6/IL6R 相互作用对沙丁胺醇反应有显著的基因-基因影响。
有证据表明，黑人与其他群体相比，β 激动剂的治疗结果可能存在差异。然而，这方面的文献仍然很少，对于实质性结论来说，其统计效能显著不足。有充分的机会进行探索黑人β激动剂安全性和疗效的研究，包括药物基因组学对反应的修饰。
