Results of a landmark Paediatric Asthma Controller Trial (PACT) conducted by Brighton and Sussex Medical School (BSMS) and the University of Dundee have shown that tailoring asthma therapy in adolescent patients according to their genetic make-up can lead to significant improvement in asthma control.
Asthma affects more than a million children in the UK and for those suffering with severe asthma, traditional treatments are not always effective.
This randomised controlled trial demonstrated that genetically guided therapy leads to a significant improvement in asthma control and quality of life using the anti-asthma tablet montelukast rather than the inhaler salmeterol with inhaled steroids under current asthma treatment guidelines.
Professor Somnath Mukhopadhyay, Chair in Paediatrics at BSMS, the Chief Investigator for the trial, said: “I hope that the results of this trial will have globally significant implications on the treatment of asthma in young people with this particular genetic susceptibility to poor medicine response in severe asthma.”
Professor Brian Lipworth, Head of the Scottish Centre for Respiratory Research, University of Dundee, said: “We previously reported observational data showing that in about 15% of these genetically susceptible individuals they have more flare ups of their asthma when taking salmeterol as an additional therapy to an inhaled steroid.
“Here we wanted to see if implementing a genetically tailored intervention whereby susceptible individuals would receive an alternative anti-asthma drug called montelukast instead of salmeterol might improve control when used as add on to inhaled steroid, as compared to a control group where prescribing was done only according to current guidelines.”
Professor Somnath Mukhopadhyay, Chair in Paediatrics at BSMS, is the Chief Investigator for the trial.
To determine if the use of the anti-asthma tablet, montelukast, was more effective in reducing severe asthma symptoms the trial compared it with the commonly used asthma inhaled drug salmeterol in conjunction with an inhaled steroid in 241 participants aged 12-18.
Few trials have specifically targeted improving control in adolescent asthma patients. This is the first randomised controlled trial in younger people looking at tailoring therapy according to the patients’ genetic make-up, making it a potential game changer for young patients with asthma to improve outcomes.
The paper concludes that genotype driven asthma prescribing is associated with a significant improvement in a clinical outcome compared to standard care in susceptible adolescent asthma patients. Out of all the participants, those with the AA homozygous genotype, 15% of patients, benefited the most.
PACT is the first randomised controlled trial of its kind addressing asthma prescribing according to Arg16Gly beta-2 genotype in adolescents. The trial is supported by the University of Dundee and BSMS, and funded by Action Medical Research and The Henry Smith charity (grant number GN2203).
It also involves collaborators at the University of Surrey, University of Aberdeen, Nanyang Technological University Singapore, the University of London and the University of Queensland. The Tayside Clinical Trials Unit was responsible for trial delivery, data management and analysis.
The trial has been published by The European Respiratory Journal. Read the study in full below.
Read the study in full here >