Asthma prescribing according to Arg16Gly beta-2 genotype: a randomised trial in adolescents

Introduction The A allele of rs1042713 (Arg16 amino acid) in the ? 2 -adrenoreceptor is associated with poor response to long-acting -agonist (LABA) young people asthma. Our aim was assess whether prescribing second-line controller LABA or a leukotriene receptor antagonist according Arg16Gly genotype would result improvements Pediatric Asthma-Related Quality Life Questionnaire (PAQLQ). Methods We performed pragmatic randomised controlled trial (RCT) via primary care clinical research network covering England and Scotland. enrolled participants aged 12–18 years asthma taking inhaled corticosteroids. 241 (mean± sd age 14.7±1.91 years) were (1:1) receive personalised (genotype directed prescribing) standard guideline care. Following 4-week run-in followed for 12 months. outcome measure change PAQLQ. Asthma control, exacerbation frequency healthcare utilisation secondary outcomes. Results Genotype-directed resulted an improvement PAQLQ compared (0.16, 95% CI 0.00–0.31; p=0.049), although this below pre-determined threshold 0.25. AA larger versus (0.42, 0.02–0.81; p=0.041). Conclusion This first RCT demonstrating that genotype-driven significant Adolescents homozygous benefited most. potential role such -adrenoceptor therapy younger more severe childhood warrants further exploration.