A Shift from Race-Based Drugs Towards Precision Medicine

Certain barriers must be overcome before precision medicine is used instead of race-based prescribing.

A recent study published by the New England Journal of Medicine describes the many challenges that must be overcome before race-based treatment decisions are eradicated.

BiDil, a drug used to treat heart failure, was the first race-based drug approved by the FDA to specifically treat African Americans with this condition.

Advocates for the drug believe it was a method to create better treatments for the group of individuals who suffered most from the disease, the researchers wrote. However, the drug was not found to be more effective in African Americans. The drug failed to get FDA approval for the general population and then was marketed to African Americans.

ACE inhibitors that treat high blood pressure and heart disease are also common race-based drugs. These drugs have been found to be less effective in black patients than in white patients.

“One result of using race to dictate therapy is that individual black patients whose hypertension would respond to ACE inhibitors may not be offered one," the authors said.

According to the study, due to genetic diversity, it is likely there are some African Americans who will not respond to a drug marketed towards African Americans and there are likely to be some non-African Americans who would respond well to the drug.

Although getting passed a race-based approach is ideal, the researchers said that getting drug manufacturers and physicians to do so may be difficult.

Makers of Plavix did not disclose that the drug was not as effective in certain patients with the liver enzyme CYP2C19, and were sued by the Attorney General of Hawaii. The company did not disclose this information likely because it would have decreased sales in the state since Asians, Native Hawaiians, and other Pacific Islanders are more likely to have inherited forms of CYP2C19 compared with whites, according to the study.

"Prescribing medications on the basis of race oversimplifies the complexities and interplay of ancestry, health, disease, and drug response," the authors said.

Researchers suggest that precision medicine could benefit patients more than prescribing based on race. Precision medicine considers genetic makeup, lifestyle, environment, and other factors to find the ideal treatment for a patient.

"There are many hurdles to overcome if a precision medicine approach to health care is to replace the use of race in treatment decisions," the authors said.

According to the study, a lack of diversity in research and clinical trials is a barrier to understanding the complicated relationship between genes, environment, and lifestyle. More patients from minority groups that reflect the diverse populations would likely remedy this problem.

The researchers also believe that costs need to be controlled for drugs that are only effective in small proportions of the population.

Researchers further states that healthcare providers need to be given resources and training to collect and analyze data.

"Precision medicine is premised on the idea of improving health outcomes by generating and using many sources of personal data to more accurately group and treat patients," the authors concluded. "If the major challenges can be overcome, precision medicine could lead the way in reducing and ultimately eliminating the use of crude racial and ethnic census categories in drug prescribing."