Multiple leading hospitals reviewing the possibility of asthma treatment using precision medicine
Precision medicine is a growing field with numerous applications in the hospital setting. This modern method of clinical treatment not only provides personalized care for a variety of illnesses based on patient-centric health characteristics, but also offers the ability to address healthcare disparities in underserved populations.
In one example, an interventional phase 4 clinical trial, sponsored by Boston Children’s Hospital, takes an innovative approach that may provide both a promising new treatment for asthma and address potential disparities in the care of asthma patients. With a start date of Sept. 8, 2021, and an estimated primary completion date of September 2023, this study uses a $10 million grant awarded by the National Institute of Allergy and Infectious Diseases (NIAID). In addition, the work builds on half a decade of successful research to provide individualized asthma treatments, according to those involved.
As many hospital and health system leaders know, asthma commonly affects children. The Boston Children’s research addresses a particularly severe form of asthma that experts there say disproportionately affects minorities. This research may be of interest to hospital leaders concerned about asthma-related hospital admissions, emergency department visits, and improving patient care in this condition area.
Predicting What Triggers Asthma Attacks
Led by Wanda Phipatanakul, MD, MS, in the Division of Immunology at Boston Children’s, the research team will provide patients with a medication called dupilumab. This medication is thought to block a receptor on the surface of certain immune cells that can cause asthma by stimulating inflammation. The phase 4 clinical trial builds on previous research that found a mutation affecting this receptor. The mutation changed the immune cell’s normal function, triggering inflammation in patients’ airways.
The gene that was previously researched, ILR4, was found to create a significant risk for asthma when mutated. When both copies of this gene are mutated, researchers found that asthma is more severe. By blocking the receptor that this gene creates, researchers expect that individuals with a ILR4 mutation will see meaningful improvements in their asthma symptoms.
Inner-City Asthma Studies Noted
Called Investigating Dupilumab’s Effect in Asthma by Genotype (IDEA), the Boston Children’s study is expected to not only address asthma care, but to provide better asthma treatment for minority healthcare groups. The ILR4 mutation is much more prevalent in minorities, and this method of precision medicine treatment will help to reduce potential healthcare disparities.
“There are a lot of disparities in asthma severity, so in this study we hope to help inner-city disadvantaged kids who disproportionately are affected by this genotype,” said Phipatanakul in a recent news release. “The treatment we are testing should especially benefit those with that genotype.”
Phipatanakul expects that the benefits of this treatment will be greatest for those who have the mutation in both copies of their ILR4 gene. “We specifically wanted to look at patients with this genotype to help those most in need and to establish a reliable biomarker for use of this drug,” she said. “Based on our earlier work, we expect that people who have two copies of the variant will respond the most.”
Wider Asthma Drug Studies at Work Throughout US
While Boston Children’s Hospital and the NIAID have both recognized the potential benefits of precision medicine for treating asthma, they are not the only groups to do so.
Cleveland Clinic is among about 30 study locations to begin a phase 2 clinical trial called Precision Interventions for Severe and/or Exacerbation-Prone Asthma Network (PrecISE). Sponsored by the National Heart, Lung, and Blood Institute (NHLBI), this study investigates six precision medicine treatment options (see the clinical trial information page) to provide patient-specific asthma care. The estimated primary completion date for PrecISE is June 2023.
“Asthma is a complex disease with variable severity and response to treatment. Our aim with this multi-center study is to enhance our ability to individualize treatments to better care for our patients with asthma,” said Serpil Erzurum, MD, Cleveland Clinic’s Chief Research and Academic Officer and principal investigator of the study in a news release. “If we can better understand individual factors such as how our genes and diet affect asthma, we can more accurately choose treatment or prevention strategies that will work best for each patient.”
Hospital leaders, physicians, and pharmacists will want to watch for the outcomes of these personalized asthma care clinical trials as they strategize their patient community initiatives now and in the future.
—Caleb Williams
Related Information:
New Research Aims to Improve Treatments and Outcomes for People with Severe Asthma
The Emerging Role of the Type 2 Inflammatory Cascade in Atopic Diseases
Precision treatment for severe asthma targets a specific mutation
Investigating Dupilumab’s Effect in Asthma by Genotype (IDEA)
PrecISE (Precision Interventions for Severe and/or Exacerbation-Prone Asthma) Network Study
Improving Asthma Management in High-risk Pediatric Patients