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Personalized Medicine in Chronic Obstructive Pulmonary Disease: How Close Are We?
Medicina personalizada en la enfermedad pulmonar obstructiva crónica: ¿cómo de cerca estamos?
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "420" "paginaFinal" => "421" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Manuel Díaz López, Beatriz Giran González, Bernardino Alcázar-Navarrete" "autores" => array:3 [ 0 => array:3 [ "nombre" => "José Manuel" "apellidos" => "Díaz López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Beatriz" "apellidos" => "Giran González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "Bernardino" "apellidos" => "Alcázar-Navarrete" "email" => array:1 [ 0 => "balcazar@telefonica.net" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "AIG de Medicina, Hospital de Alta Resolución de Loja, Agencia Sanitaria Hospital de Poniente, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "CIBERES, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Medicina personalizada en la enfermedad pulmonar obstructiva crónica: ¿cómo de cerca estamos?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">One of the major challenges currently facing medicine in general, and respiratory medicine in particular, is precision medicine.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> This approach, in which each patient receives the most appropriate treatment (pharmacological or otherwise) according to their characteristics (biological, genetic, environmental), optimizing the benefit and minimizing side effects, has been confirmed as a key strategy that will undoubtedly shift our daily care pathways from evidence-based medicine to personalized medicine.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although precision medicine initially began to develop in the areas of medical oncology and hereditary diseases, data are beginning to emerge in the field of respiratory medicine that will bring us closer to this approach.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> Indeed, now, at the end of the second decade of this century, these data are already influencing how we manage chronic obstructive pulmonary disease (COPD).</p><p id="par0015" class="elsevierStylePara elsevierViewall">The first step toward precision medicine is the discovery of biomarkers that help us select different groups of patients who have shared therapeutic responses or disease patterns. This process began in the early years of this century and led to the concept of clinical phenotypes<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> and the development of clinical practice guidelines, such as GesEPOC, the Spanish COPD guidelines, that are based on clinical phenotypes.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">5</span></a> The clinical phenotype concept is merely an intermediate step and does not fully encompass the notion of precision medicine, so more progress in this area is necessary. This is the current situation with regard to the so-called “treatable traits”.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The most studied treatable trait in recent years in the field of COPD is the presence of eosinophils in peripheral blood.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> Eosinophil concentrations in peripheral blood are a reliable biomarker of response to inhaled corticosteroids (ICS)<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> in terms of reducing exacerbations compared to other therapeutic options. It is also a marker of the risk of side effects from ICS use (such as pneumonia). In fact, the number needed to treat (NNT) with ICS to prevent at least 1 moderate or severe exacerbation in the subgroup of patients with a high eosinophil count (>300<span class="elsevierStyleHsp" style=""></span>cells/mL) is less than 10. However, eosinophils only appear to play a role in the prevention of exacerbations in patients with frequent exacerbations, and the role of this biomarker in non-exacerbators is less clear.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">9,10</span></a> Following the latest GOLD 2019 recommendations released at the end of last year, eosinophil counts are now one of the first examples of COPD precision medicine included in clinical practice guidelines.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We also have examples of precision medicine in the field of bronchodilators. Perhaps one of the most interesting comes from a <span class="elsevierStyleItalic">post hoc</span> analysis of the POET-COPD study which investigated differences in response to 2 long-acting bronchodilators in the prevention of exacerbations.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> In this study, patients with the β<span class="elsevierStyleInf">2</span>-adrenergic receptor (ADRB2) polymorphism Arg16Arg had a better response to salmeterol in the prevention of exacerbations compared to carriers of other polymorphisms (Arg16Gly and Gly16Gly).</p><p id="par0030" class="elsevierStylePara elsevierViewall">More recently, a study of 64 COPD patients in an open-label crossover clinical trial<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> demonstrated that different clinical characteristics, along with gene expression and damaged-gene scores, can help predict which patients will respond significantly to the use of bronchodilators (defining this response as an increase of >100<span class="elsevierStyleHsp" style=""></span>mL in FEV<span class="elsevierStyleInf">1</span> after 4 weeks of pharmacological treatment).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, data from a recent crossover clinical trial<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> have shown that different pharmacological responses in COPD can be seen in different drug families, and even within the same drug family, individual response may vary considerably. In this clinical trial, which compared 2 marketed dual bronchodilator (DB) combinations, 52% of patients showed a clinically significant response in terms of FEV<span class="elsevierStyleInf">1</span> to one of the DBs and 19% of patients responded similarly to the other. This effect was observed in both the previously treated population and the treatment-naïve population.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a> Unfortunately, no blood samples were obtained during this study that would help define which biomarkers indicated a higher probability of responding to one DB or the other.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, we are beginning to see examples of precision medicine in the field of COPD, and the results achieved with this type of approach are more promising than with “one size fits all” medicine. However, we are still only halfway there, and we will need clinical trials in the coming years to assess the real effectiveness of interventions based on similar clinical and biological patterns. To this end, the search for biomarkers and the re-analysis of large databases that contain data on the different “omics” in COPD will be equally necessary.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0045" class="elsevierStylePara elsevierViewall">Dr. Díaz López declares no conflicts of interest associated with this article. Dr. Girán González declares no conflicts of interest associated with this article. Dr. Alcázar-Navarrete declares that he has received personal honoraria, grants for research projects and non-financial aid in the last 5 years from GSK, Novartis AG, Boehringer Ingelheim, Chiesi, Laboratorios Menarini, and Astra-Zeneca, unassociated with this article. Dr. Alcázar-Navarrete is also the holder of registered patent P201730724.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Díaz López JM, Giran González B, Alcázar-Navarrete B. Medicina personalizada en la enfermedad pulmonar obstructiva crónica: ¿cómo de cerca estamos? Arch Bronconeumol. 2020;56:420–421.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new initiative on precision medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.S. Collins" 1 => "H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 53 | 30 | 83 |
| 2024 September | 60 | 21 | 81 |
| 2024 August | 65 | 45 | 110 |
| 2024 July | 42 | 18 | 60 |
| 2024 June | 51 | 24 | 75 |
| 2024 May | 95 | 25 | 120 |
| 2024 April | 31 | 28 | 59 |
| 2024 March | 36 | 18 | 54 |
| 2024 February | 29 | 22 | 51 |
| 2023 August | 1 | 0 | 1 |
| 2023 March | 10 | 8 | 18 |
| 2023 February | 53 | 17 | 70 |
| 2023 January | 29 | 20 | 49 |
| 2022 December | 63 | 22 | 85 |
| 2022 November | 59 | 13 | 72 |
| 2022 October | 57 | 32 | 89 |
| 2022 September | 34 | 19 | 53 |
| 2022 August | 35 | 40 | 75 |
| 2022 July | 30 | 32 | 62 |
| 2022 June | 36 | 33 | 69 |
| 2022 May | 32 | 36 | 68 |
| 2022 April | 37 | 29 | 66 |
| 2022 March | 45 | 52 | 97 |
| 2022 February | 13 | 18 | 31 |
| 2020 October | 1 | 0 | 1 |
| 2020 June | 1 | 2 | 3 |
Show all
