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Race and precision medicine: is it time for an upgrade?

The Pharmacogenomics Journal volume 19, pages 1–4 (2019)Cite this article

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The race concept has been extensively used as a biological characteristic to categorize individuals into groups based on distinct geographical ancestry. However, others view race as a social and cultural construct to categorize the population based on the individuals’ physical characteristics and shared social norms. Moreover, biologists and anthropologists have heavily debated the race concept recognizing that race as a biologically invalid classification, partly because there is more genetic variation within groups than between them [1, 2]. Therefore, expanding on the different race-related perspectives and their implications in patient care are the purpose of this paper.

The medical, scientific, and regulatory fields have long used the race concept to provide and guide a more tailored drug therapy to patients based on data derived from clinical trials and large meta-analyses. A prime example, the use of angiotensin-converting enzyme inhibitors, was long believed to be ineffective in blacks due to reduced circulating levels of plasma renin relative to other racial groups. This knowledge of differential response resulted in a race-based guideline recommendation for the management of hypertension in Blacks vs. Non-Blacks [3]. Moreover, the combination drug therapy of isosorbide/hydralazine was found to be effective in African-American patients with heart failure to become the first race-based approved drug in the US [4]. Other racial-based recommendations are also highlighted in select clinical treatment guidelines and Food and Drug Administration FDA, approved drug labels [5,6,7]. For instance, the guidelines for the management of blood cholesterol in adults warrant initiating a lower dose of rosuvastatin in Asian-descent patient population than their other population counterparts due to the increased risk of myopathy [6]. Similarly, the American College of Rheumatology guidelines, caution about the use of allopurinol in certain Asian sub-population groups due to the increased risk of developing Stevens–Johnson Syndrome [7]. For a summary of racial and ethnic-based recommendations within select FDA approved drug labels, see Table 1.

Table 1. A summary of racial and ethnic-based recommendations within select FDA approved drug labels
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References

  1. Jorde LB, Wooding SP. Genetic variation, classification and ‘race’. Nat Genet. 2004;36(11 Suppl):S28–33.

    Article  CAS  Google Scholar 

  2. MacEachern S. The concept of race in contemporary anthropology. Race and Ethnicity: The United States and the World 2011, 34–57

  3. Officers A. Coordinators for the ACRGTA, lipid-lowering treatment to prevent heart attack trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981–97.

    Article  Google Scholar 

  4. Brody H, Hunt LM. BiDil: assessing a race-based pharmaceutical. Ann Fam Med. 2006;4:556–60.

    Article  Google Scholar 

  5. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA . 2014;311:507–20.

    Article  CAS  Google Scholar 

  6. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889–934.

    Article  Google Scholar 

  7. Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012;64:1431–46.

    Article  CAS  Google Scholar 

  8. Jones NA, Bullock J (2012). The two or more races population. pp 1–23 United States: U.S. Census Bureau; 2010.

  9. United State Census Bureau. Midwest Home to Most of the Counties With Decreases in Median Age. 2018 https://www.census.gov/newsroom/press-releases/2018/popest-characteristics.html. June 22nd 2018.

  10. Roman YM, Culhane-Pera KA, Menk J, Straka RJ. Assessment of genetic polymorphisms associated with hyperuricemia or gout in the Hmong. Per Med. 2016;13:429–40.

    Article  CAS  Google Scholar 

  11. Genomes Project C, Auton A, Brooks LD, Durbin RM, Garrison EP, Kang HM, et al. A global reference for human genetic variation. Nature. 2015;526:68–74.

    Article  Google Scholar 

  12. A global reference for human genetic variation, Nature volume 2015;526:68–74.

  13. Ahmed S, Zhou Z, Zhou J, Chen SQ. Pharmacogenomics of drug metabolizing enzymes and transporters: relevance to precision medicine. Genom, Proteom Bioinforma. 2016;14:298–313.

    Article  Google Scholar 

  14. Wu AH, White MJ, Oh S, Burchard E. The Hawaii clopidogrel lawsuit: the possible effect on clinical laboratory testing. Pers Med. 2015;12:179–81.

    Article  CAS  Google Scholar 

  15. Adams SA, Petersen C. Precision medicine: opportunities, possibilities, and challenges for patients and providers. J Am Med Inform Assoc. 2016;23:787–90.

    Article  Google Scholar 

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  1. Pharmacy Practice Department, Daniel K. Inouye College of Pharmacy, University of Hawaii, Hawaii, USA

    Youssef M. Roman Pharm.D., Ph.D.

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  1. Youssef M. Roman Pharm.D., Ph.D.
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Correspondence to Youssef M. Roman Pharm.D., Ph.D..

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Roman, Y.M. Race and precision medicine: is it time for an upgrade?. Pharmacogenomics J 19, 1–4 (2019). https://doi.org/10.1038/s41397-018-0046-0

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