Ethnic Differences In Response Research Articles

Ethnic Differences in Response to Oral Vitamin D Supplementation: A Systematic Review and Meta-analysis.

Individual variability in oral vitamin D supplement response hinders the understanding of its clinical impact, and while ethnicity has been implicated in this variability it has not been well described. The aim was to systematically assess the impact of ethnicity on response to oral vitamin D supplementation. The Web of Science and PubMed databases were searched for articles published from 1960 to the end of 2020. All trials in adults measuring 25(OH)D3 blood levels were included. Two reviewers independently extracted the data from the eligible studies. The change in 25(OH)D3 blood levels (95% CI) and P values were extracted, and grouped according to ethnicity, then subjected to random-effects meta-analysis. The primary outcome measurement was mean serum 25(OH)D3 levels and the secondary outcome was dose-adjusted mean serum 25(OH)D3 levels, both compared with baseline. A total of 18 studies were identified, and data from 1131 participants were extracted. Body mass index (BMI) and dose were significant covariates (Pearson correlation coefficient, P = .016 and .017) and were normalized in the meta-analysis to minimize heterogeneity, but latitude was not (P = .66). Meta-analysis showed an effect of ethnicity on dose and BMI-adjusted mean serum 25(OH)D3 levels compared with baseline (P < .00001, I2 = 98%). Asian and White study participants demonstrated a statistically higher increase in dose and BMI-adjusted 25(OH)D3 blood levels (183 nmol/L [95% CI, 163-203] and 173 nmol/L [95% CI, 152-194], respectively), compared with Arab and Black study participants (37 nmol/L [95% CI, 35-39] and 99 nmol/L [95% CI, 90-108]) using repeated t tests. Sensitivity analysis demonstrated that these findings were not impacted by potential study bias or the inclusion of immigrant populations. Ethnicity had an impact on oral vitamin D response. Further prospective studies should examine if ethnicity-based dose stratification in both clinical practice and clinical trials is warranted. PROSPERO registration no. CRD42023410076.

Pathological complete response rate to anthracycline versus non−anthracycline based chemotherapy regimens in localized and regional HER2 neu positive breast cancer.

e12632 Background: Debate over the need of anthracycline as part of neoadjuvant chemotherapy in HER2-neu early breast cancer was addressed in many trials with results favoring similar outcomes with or without anthracycline. This was not adopted fully in Saudi Arabia because of concern regarding ethnic differences in response to treatment. We conducted this retrospective analysis to evaluate if there is any difference in pathological complete response rate (PCR) in patients with early HER2-neu positive breast cancer depending on neoadjuvant chemotherapy regimen. Methods: Patients with HER2-neu positive early breast cancer who were treated with neoadjuvant chemotherapy at Johns Hopkins Aramco Healthcare (JHAH) facility between the year 2018 and 2022 were all evaluated for pathological subtype, HER2-neu status and type of neoadjuvant chemotherapy administered. Pathological response status was evaluated in all patients and PCR was measured to see if there was any difference depending on the use of anthracycline (AC) or non-anthracycline (non-AC) based chemotherapy regimen. Patient demographics, tumor characteristics, clinical stage, treatments and outcomes were collected via JHAH’s oncology registry. Categorical variables are reported as frequencies and percentages. The association between chemotherapy regimen AC vs non-AC based and PCR was analyzed using Fisher Exact Test. p-value &lt;0.05 was considered statistically significant. Analyses were conducted using JMP version 15. Results: In this study 59 HER2-neu positive early breast cancer patients were identified. We examined their clinical characteristics and treatment outcomes. Median age was 57. The most prevalent histology was invasive carcinoma of no special type (79.66%), Estrogen receptor positivity was observed in 72.88% of patients, while progesterone receptor positivity was seen in 62.71% of cases. Majority of patients were alive (96.61%) at the time of data collection. There was no significant difference in clinical stage in both groups. The association between chemotherapy type and pathological response was assessed. Among patients receiving AC chemotherapy (n=29), 55.17% achieved PCR, while for patients receiving Non-AC chemotherapy (n=30), the PCR rate was 50%. However, this difference was not statistically significant (p-value = 0.8). Conclusions: In our cohort of HER-neu positive early breast cancer patients who received neoadjuvant therapy there seems to be no significant difference in PCR with AC or Non-AC based chemotherapy regimens. This is concordant with the international trends.

Diversity Plans and Postmarketing Studies: First Impressions of Anticipated Diversity Requirements in the United States.

Recent Food and Drug Administration (FDA) draft guidelines are intended to improve representation and formalize the assessment of race and ethnicity in drug development, but how regulators and industry stakeholders plan to implement and enforce new requirements is still being determined. Here, a 10-question survey was developed to assess the experiences of industry stakeholders in developing diversity plans. These survey results informed an analysis of postmarketing studies to understand how diversity requirements have been enforced to date. Among 13 survey responders, experience submitting and receiving feedback on diversity plans was limited. A variety of challenges have been associated with developing these plans, including questions regarding regulatory guidance. Sponsors have utilized several data sources, including real-world datasets, to define enrollment goals. Diversity-related postmarketing studies most commonly related to oncologic diseases, and endpoints frequently related to efficacy. Most marketing applications associated with diversity-related postmarketing studies received Orphan drug designation (ODD) and Accelerated Approval. These results show that industry experience with diversity plans remains limited in the absence of finalized regulatory guidance. Sponsors are beginning to develop strategies for submitting diversity plans, which include identifying key functions and data sources to support enrollment goals, although definitive conclusions were difficult to draw from the small responder pool. In the postmarketing setting, studies are already underway to improve the understanding of racial and ethnic differences in responses to approved drugs. Development programs relating to oncology, which has historically suffered from a lack of diverse representation, have been a primary focus of such studies thus far.

Liraglutide 3.0 mg in the treatment of adults with obesity and prediabetes using real-world UK data: A clinical evaluation of a multi-ethnic population.

UK guidelines recommend liraglutide 3.0 mg in adults treated within specialist weight management services with BMI ≥35 kg/m2, prediabetes and high cardiovascular disease risk. We aimed to clinically evaluate liraglutide 3.0 mg in specialist weight management services. We evaluated liraglutide 3.0 mg in weight management services at Guys and St Thomas' NHS Foundation Trust. Objective body weight (BW) was measured at baseline and 4 months, allowing classification as 'responders' (≥5% BW reduction) and 'non-responders' (<5% BW reduction). One hundred and twenty-one patients were evaluated. At 4 months, 76.0% attended follow-up (82.6% responders, 17.4% non-responders); BW (-8.6 kg, 95%CI:-9.8, -7.4 kg), BMI (-3.2 kg/m2, 95%CI: -3.6, -2.8) and %-BW (-6.6%, IQR: -8.8%, -5.2%) significantly reduced. In responders, HbA1c reduced by -5.0 mmol/mol (IQR: -7.0. -4.0 mmol/mol). In responders BW continued to reduce up to 12 months (4 m: -10.2 kg, p < .0001; 6 m: -15.6 kg, p < .0001; 9 m: -16.5 kg, p < .0001; 12 m: -16.7 kg, p < .01). Those of Black African and Caribbean ethnicity experienced less BW loss than those of white ethnicity (4.12 kg, p = .017) and had a greater attrition rate. In adults with obesity and prediabetes who are treated within specialist weight management services, liraglutide 3.0 mg reduces BW and HbA1c. Those of Black African and Caribbean ethnicity experienced less BW reduction and greater attrition at 4 months. Further evaluation of the ethnic differences in response to obesity pharmacotherapy is required.

Abstract B010: Racial and ethnic differences in response to neoadjuvant chemotherapy and the impact on overall survival among early-stage ERBB2-low breast cancer patients

Abstract Background: Recent studies have reported a pathologic complete response (pCR) rate of 13.0-36.3% in patients (pts) with early-stage human epidermal growth factor receptor-2 (ERBB2 [formerly HER2])-low breast cancer after neoadjuvant chemotherapy (NACT), however, have found contradicting results comparing survival outcomes between pts with ERBB2-low and pts with ERBB2-0 tumors. Further, racial/ethnic differences in pCR, and in overall survival (OS) by pCR status, among early-stage ERBB2-low breast cancer pts after NACT are unknown. Methods: We analyzed data from early-stage ERBB2-low breast cancer pts in the 2010-2020 National Cancer Database, a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. Racial/ethnic groups included Asian/Pacific Islander (API), American Indian/Alaska Native (AIAN), Black, Hispanic, and White. ERBB2-low was defined as having an IHC score of 1+ or 2+, without gene amplification by FISH. pCR (ypT0/Tis ypN0) status was dichotomized as “achieved/did not achieve,” modeled using multivariable logistic regression. OS, measured from the surgery date to the date of death or the last contact, was modeled using multivariable Cox proportional hazard regression by pCR status. Results: Of 25,577 pts (mean age 54 years [SD=12]), most (66.0%) were White, followed by 18.0% Black, 9.1% Hispanic, 5.1% API, and 1.8% AIAN. Overall, 15.2% achieved pCR. Black pts achieved a 17.4% pCR rate, Hispanic 16.0%, White 14.7%, API 13.5%, and AIAN 10.9%. After adjusting for clinicopathological characteristics, AIAN pts had lower odds of pCR achievement than White pts (adjusted odds ratio [AOR]=0.66, 95% CI: 0.48-0.91). There were no statistically significant differences in the odds of pCR achievement between Hispanic and White pts (AOR=1.12, 95% CI: 0.98-1.29), between Black and White pts (AOR=1.01, 95% CI: 0.92-1.12), or between API and White pts (AOR=0.95, 95% CI: 0.79-1.14). Among pts who did not achieve pCR, API (adjusted hazard ratio [aHR]=0.62; 95% CI: 0.51-0.76) and Hispanic (aHR=0.77, 95% CI: 0.67-0.89) pts had a significantly lower risk of death than White pts; mortality risk was marginally statistically significant comparing Black with White pts (aHR=1.07, 95% CI:1.00-1.17) and was not statistically significant comparing AIAN with White pts (aHR=0.88, 95% CI: 0.65-1.18). Among pts who achieved pCR, we did not observe statistically significant differences in the risk of death between Hispanic and White pts (aHR=1.08, 95% CI: 0.66-1.78), between Black and White pts (aHR=0.77, 95% CI: 0.55-1.09), between API and White pts (aHR=0.41, 95% CI: 0.15-1.12), or between AIAN and White pts (aHR=0.35, 95% CI: 0.05-2.50). Conclusions: In this large national cohort of pts with early-stage ERBB2-low breast cancer, post-NACT pCR was highest in Black and lowest in AIAN pts. Compared with White pts, only AIAN pts showed significantly lower odds of achieving pCR. Our findings suggest further investigation of possible causes of racial/ethnic OS differences after NACT in this patient population. Citation Format: Jincong Q. Freeman, James L. Li, Olasubomi Omoleye. Racial and ethnic differences in response to neoadjuvant chemotherapy and the impact on overall survival among early-stage ERBB2-low breast cancer patients [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B010.

Ethnic Differences in Response to COVID-19: A Study of American-Asian and Non-Asian College Students

Asian American students have experienced additional physical and emotional hardships associated with the COVID-19 pandemic due to increased xenophobic and anti-Asian discrimination. This study investigates different coping patterns and risk factors affecting Asian and non-Asian college students in response to COVID-19 challenges by studying the differences in their responses within four domains after the onset of the pandemic: academic adjustment, emotional adjustment, social support, and discriminatory impacts related to COVID-19. We first employed a machine learning approach to identify well-adjusted and poorly adjusted students in each of the four domains for the Asian and non-Asian groups, respectively. Next, we applied the SHAP method to study the principal risk factors associated with each classification task and analyzed the differences between the two groups. We based our study on a proprietary survey dataset collected from U.S. college students during the initial peak of the pandemic. Our findings provide insights into the risk factors and their directional impact affecting Asian and non-Asian students' well-being during the pandemic. The results could help universities establish customized strategies to support these two groups of students in this era of uncertainty. Applications for international communities are discussed.

Ethnic differences in response to atypical antipsychotics in patients with schizophrenia: individual patient data meta-analysis of randomised placebo-controlled registration trials submitted to the Dutch Medicines Evaluation Board.

Little is known about the effect of ethnicity on the response to antipsychotic medication in patients with schizophrenia. To determine whether ethnicity moderates the response to antipsychotic medication in patients with schizophrenia, and whether this moderation is independent of confounders. We analysed 18 short-term, placebo-controlled registration trials of atypical antipsychotic medications in patients with schizophrenia (N = 3880). A two-step, random-effects, individual patient data meta-analysis was applied to establish the moderating effect of ethnicity (White versus Black) on symptom improvement according to the Brief Psychiatric Rating Scale (BPRS) and on response, defined as >30% BPRS reduction. These analyses were corrected for baseline severity, baseline negative symptoms, age and gender. A conventional meta-analysis was performed to determine the effect size of antipsychotic treatment for each ethnic group separately. In the complete data-set, 61% of patients were White, 25.6% of patients were Black and 13.4% of patients were of other ethnicities. Ethnicity did not moderate the efficacy of antipsychotic treatment: pooled β-coefficient for the interaction between treatment and ethnic group was -0.582 (95% CI -2.567 to 1.412) for mean BPRS change, with an odds ratio of 0.875 (95% CI 0.510-1.499) for response. These results were not modified by confounders. Atypical antipsychotic medication is equally effective in both Black and White patients with schizophrenia. In registration trials, White and Black patients were overrepresented relative to other ethnic groups, limiting the generalisability of our findings.

Ethnic differences in response to lifestyle intervention for the prevention of type 2 diabetes in adults: A systematic review and meta-analysis.

The risk of type 2 diabetes mellitus (T2DM) varies by ethnicity, but ethnic differences in response to diabetes prevention interventions remain unclear. This systematic review and meta-analysis assessed ethnic differences in the effects of lifestyle interventions on T2DM incidence, glycemic outcomes (fasting glucose, 2-h glucose, HbA1c ), anthropometric measures (weight, BMI, waist circumference), and lifestyle behaviors (physical activity, energy intake, energy from fat, fiber intake). MEDLINE, EMBASE, and other databases were searched (to June 15, 2020) for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American, and African groups. Forty-four studies were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in T2DM incidence, glycemic outcomes, anthropometric measures, physical activity, and energy intake (all P < 0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI, and waist circumference (all P < 0.05) but not for T2DM incidence, fasting glucose, HbA1c , and physical activity (all P > 0.05). Few studies in non-European groups reported dietary intake. Lifestyle interventions in different ethnic groups may have similar effects in reducing incidence of T2DM although this needs to be confirmed in further studies.

1386Ethnic differences in lifestyle interventions for diabetes prevention: a systematic review and meta-analysis

Abstract Background The risk of type 2 diabetes varies by ethnicity, but ethnic differences in response to lifestyle interventions for diabetes prevention remain unclear. This systematic review and meta-analysis aimed to assess differences in the effects of lifestyle interventions on diabetes incidence, glycemic outcomes and anthropometric measures between ethnic groups. Methods MEDLINE, EMBASE, Pubmed, CINAHL, PsycInfo and EBM Reviews were searched (to June 2020) with no language restriction for randomized and non-randomized controlled trials on lifestyle interventions involving diet and/or physical activity in adults at risk of type 2 diabetes. Ethnicity was categorized into European, South Asian, Other Asian, Middle Eastern, Latin American and African groups based on the World Bank regions. Risk ratios for diabetes incidence and mean differences for glycemic outcomes (fasting glucose, 2-h glucose, HbA1c) and anthropometric measures (weight, BMI, waist circumference) were pooled using random-effects meta-analysis. Results Sixty articles representing 43 studies (18,691 participants) were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in diabetes incidence, glycemic outcomes and anthropometric measures compared with controls (all P&amp;lt;0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI and waist circumference (all P&amp;lt;0.05) but not for diabetes incidence, fasting glucose and HbA1c (all P&amp;gt;0.05). Conclusions Lifestyle interventions are similarly effective in reducing diabetes incidence, fasting glucose and HbA1c for all ethnic groups, however, 2-h glucose and anthropometric outcomes should be optimized in certain ethnic groups. Key messages Lifestyle intervention is likely effective in preventing the progression to type 2 diabetes equally across all ethnic groups.

Racial and ethnic differences in response to treatment for Marfan syndrome - Corrigendum.

Racial and ethnic differences in response to treatment for Marfan syndrome - Corrigendum.

Effects of MitoQ on Central Hemodynamics, Arterial Stiffness, and Oxidative Stress In Healthy, Young Adults

PURPOSE Cardiovascular disease is characterized by blood pressure (BP) dysregulation and vascular dysfunction, secondary to vascular oxidative stress. Exogenous antioxidants mitigate vascular oxidative stress by scavenging reactive oxygen species (ROS). MitoQ, a mitochondrial specific antioxidant improves vascular function and reduces elevated arterial stiffness in older adults. However, it is unclear if MitoQ improves vascular function in healthy young adults for primary prevention purposes. Therefore, central hemodynamics, arterial stiffness, and measures of oxidative stress were assessed in healthy young adults before and after acute MitoQ (or placebo) supplementation. METHODS Eleven participants (six females, age: 26±4 years, BMI: 25±3 kg/m2, screening BP: 109±10/65±4 mmHg, Mean±SD) reported to our laboratory for two separate sessions (crossover design) and randomly assigned either a placebo or MitoQ protocol (100-160mg, depending on body mass). Sessions were separated by ≥72-hour wash out period. Laboratory measures were performed before and 45 minutes after MitoQ (or placebo) capsules were ingested. Following ≥10 minutes of quiet rest, triplicate readings of brachial (oscillometric) and aortic BP (SphygmoCor) were obtained. We assessed carotid-femoral pulse wave velocity (PWV) and augmentation index as indices of arterial stiffness. We obtained blood samples via intravenous catheter placement to assess ROS levels with electron paramagnetic resonance and plasma superoxide dismutase activity using an enzymatic assay kit. 2-way ANOVAs were performed to determine effects on treatment x time interaction. RESULTS No significant treatment x time interactions for brachial (p=0.52) and aortic (p=0.64) systolic BP readings, or brachial (p=0.34) and aortic (p=0.11) diastolic BP readings were observed. However, brachial systolic BP tended to modestly increase after capsule ingestion (placebo:114±8 to 118±9; MitoQ: 116±11 to 118±8; time: p=0.05). Carotid-femoral PWV did not change following placebo (4.3±0.7 to 4.5±0.8 m/s) or MitoQ (4.3±0.7 to 4.4±0.8 m/s) ingestion (time: p=0.35, interaction p=0.30). Augmentation index decreased from pre- to post- capsule ingestion for both placebo (14±9 to 11±8 %) and MitoQ (14±9 to 10±8 %; time: p<0.01) with no significant interaction (p=0.28). There was no significant treatment x time interaction for Blood ROS (p=0.99) concentration or plasma superoxide dismutase activity (p=0.89). CONCLUSIONS While additional data are needed to build our sample size and determine if there are racial or ethnic differences in responses, our preliminary findings suggest that acute MitoQ supplementation does not influence central hemodynamics or arterial stiffness in healthy, young adults.

Racial and ethnic differences in response to treatment for Marfan syndrome.

To determine whether racial/ethnic differences exist for the treatment of Marfan syndrome aortopathy. The 2014 Pediatric Heart Network randomised trial of losartan versus atenolol in Marfan syndrome paediatric and young adult patients showed no treatment differences in the rate of aortic root growth over 3 years; however, they did not examine racial/ethnic differences, and recent data suggest that angiotensin receptor blockers may have different pharmacologic effects in different racial/ethnic populations. We performed a secondary analysis of public-use data from the Pediatric Heart Network randomised trial comparing the differences by race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic patients) amongst the treatment groups for the primary outcome of rate of aortic root enlargement by z score and secondary outcome of rate of change of absolute diameter of aortic root, z score and absolute diameter of ascending aorta, and blood pressure changes. For aortic root enlargement by z score amongst non-Hispanic White patients, patients on losartan exhibited an annual z score change of -0.090 ± 0.016, compared to -0.146 ± 0.015 for those on atenolol (p = 0.01), favouring atenolol. For Hispanic and non-Hispanic Black patients, there was no difference in primary or secondary outcomes between treatment groups. Non-Hispanic White patients had a small, but statistically significantly greater decrease in aortic root z score favouring atenolol over losartan. There were no significant differences amongst Hispanic or non-Hispanic Black patients, which may be due to relatively small size numbers. These findings may have important implications for medication selection by race/ethnicity in Marfan syndrome patients, which has not previously been evaluated in studies.

Racial and Ethnic Differences in Biomarkers, Health Status, and Cardiac Remodeling in Patients With Heart Failure With Reduced Ejection Fraction Treated With Sacubitril/Valsartan

Among patients with heart failure and reduced ejection fraction (left ventricular (LV) ejection fraction ≤40%), sacubitril/valsartan (S/V) treatment is associated with improved health status and reverse cardiac remodeling. Data regarding racial and ethnic differences in response to S/V are lacking. This was an analysis from the PROVE-HF study (Prospective Study of Biomarkers, Symptom Improvement and Ventricular Remodeling During Entresto Therapy for Heart Failure). Longitudinal changes in NT-proBNP (N-terminal pro-B-type natriuretic peptide), cardiac reverse remodeling, and health status scores were compared between groups using multivariate latent growth curve modeling. Among the 782 patients included in this study, 22.7% were non-Hispanic Black (from here referred to as Black), 14.9% were Hispanic, and 62.4% were non-Hispanic White (from here referred to as White). At baseline, compared with White patients, Black and Hispanic patients had lower NT-proBNP (g=0.34) and differences between groups in baseline values for LV end-diastolic volume index and LV end-systolic volume index were negligible (g<0.10). Following S/V initiation, NT-proBNP decreased in all 3 groups (P<0.0001) associated with improvements in LV ejection fraction, LV end-diastolic volume index, and LV end-systolic volume index. Although total improvement in LV measures was similar between groups, Black patients averaged larger gains in the first half of the trial while White patients averaged larger gains in the second half. Improvements in Kansas City Cardiomyopathy Questionnaire-23 Total Symptom scores were seen in all 3 groups. Treatment with S/V was well-tolerated. Among Black, Hispanic, and White patients with heart failure and reduced ejection fraction, treatment with S/V was associated with similar reduction in NT-proBNP, improvement in health status, and reverse remodeling. More data regarding racial and ethnic responses to heart failure and reduced ejection fraction treatment are needed. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02887183.

Are there any ethnic differences in the efficacy and safety of immune checkpoint inhibitors for treatment of lung cancer?

Immunotherapy, especially immune checkpoint inhibitors, has revolutionized the treatment of non-small cell lung cancer. However, data on ethnic differences in response to these treatments are still lacking. We reviewed the currently available clinical data on immune checkpoint inhibitors and analyzed the ethnic difference in terms of treatment efficacies and side effects. Despite different epidemiology, genetic susceptibility and molecular profiles, Asian lung cancer patients demonstrated comparable outcomes to Western patients in terms of response rates and survival benefits. The incidence of immune-related adverse events has been reported with a higher incidence in Japanese patients, but was not consistent across other Asian patient populations, and warrants further investigation.

Racial and Ethnic Differences in Response to Anticoagulation: A Review of the Literature

Introduction: Anticoagulants are among the most frequently prescribed medications in the United States. Racial and ethnic disparities in incidence and outcomes of thrombotic disorders are well-documented, but differences in response to anticoagulation are incompletely understood. Objective: The objective of this review is to describe the impact of race and ethnicity on surrogate and clinical end points related to anticoagulation and discuss racial or ethnic considerations for prescribing anticoagulants. Methods: A PubMed and MEDLINE search of clinical trials published between 1950 and May 2018 was conducted using search terms related to anticoagulation, specific anticoagulant drugs, race, and ethnicity. References of identified studies were also reviewed. English-language human studies on safety or efficacy of anticoagulants reporting data for different races or ethnicities were eligible for inclusion. Results: Seventeen relevant studies were identified. The majority of major trials reviewed for inclusion either did not include representative populations or did not report on the racial breakdown of participants. Racial differences in pharmacokinetics, dosing requirements, drug response, and/or safety end points were identified for unfractionated heparin, enoxaparin, argatroban, warfarin, rivaroxaban, and edoxaban. Conclusions: Race appears to influence drug concentrations, dosing, or safety for some but not all direct oral anticoagulants. This information should be considered when selecting anticoagulant therapy for nonwhite individuals.

Ethnic differences in response to directive vs. non-directive brief intervention for subsyndromal depression

Objective: Analog research suggests that directive interventions might increase treatment engagement for non-symptomatic Asian American (AA) students; however, no studies have assessed whether directiveness improves therapy processes or clinical outcomes for AAs with mental health symptoms. This study tested the comparative efficacy of brief directive vs. non-directive intervention for AAs and European Americans (EAs) with subsyndromal depression. Method: Participants were randomly assigned directive, non-directive, or cultural values interview conditions, and assessed three times over six months. Directive and non-directive treatment involved meeting with a therapist for a single, 20-minute session to receive psychoeducation and personalized feedback on depressive symptoms and coping strategies. Cultural values participants also met with a therapist. Results: Although results were mixed for the overall sample, directive treatment was generally superior to non-directive treatment and cultural values at addressing depressive symptoms, coping behavior, and working alliance. Ethnicity did moderate treatment effects for some outcomes, but in an unexpected manner. At six-month follow-up, the directive intervention was more effective than cultural values at reducing depressive symptoms for AAs; however, the cultural values condition was more effective than the non-directive intervention at reducing depressive symptoms for EAs. Conclusion: Mixed evidence was found for directiveness as an Asian-specific treatment enhancement.Clinical or methodological significance of this article: This article adds to a complicated body of research and clinical work aiming to inform best practices for ethnic minorities. We found some evidence that a directive therapeutic style may be a “culturally invariant” clinical technique that could be beneficial to Asian American and European American populations alike. Yet, other findings suggest that directiveness might be uniquely advantageous for Asian Americans, particularly for long-term improvement of depressive symptoms.

Is Pulse Oximetry Useful for Screening Neonates for Critical Congenital Heart Disease at High Altitudes?

Now that pulse oximetry is used widely to screen for critical congenital heart disease, it is time to consider whether this screening method is applicable to those who live at high altitudes. Consideration of basic physical principles and reports from the literature indicate that not only is the 95% cutoff point for arterial oxygen saturation incorrect at high altitudes, but the lower saturations are accompanied by greater variability and therefore there is the possibility of a greater percentage of false-positive screening tests at high altitudes. Because of ethnic differences in response to high altitudes, normative data will have to be collected separately in different countries and perhaps for different ethnic groups.

Are There Any Racial and Ethnic Differences in Response to Medicines in Japanese Patients?

Are There Any Racial and Ethnic Differences in Response to Medicines in Japanese Patients?

Genetic variation in the α1A-adrenergic receptor and phenylephrine-mediated venoconstriction.

There is large interindividual variability and ethnic differences in phenylephrine-mediated vasoconstriction. We tested the hypothesis that genetic variation in ADRA1A, the α1A adrenergic receptor gene, contributes to the variability and ethnic differences. We measured local dorsal hand vein responses to increasing doses of phenylephrine in 64 Caucasians and 42 African-Americans and genotyped for 32 ADRA1A SNPs. The ED50 ranged from 11 to 5442 ng/min, and the Emax ranged from 13.5% to 100%. The rs574647 variant was associated with a trend towards lower logED50 in each race and in the combined cohort (P=0.008). Additionally, rs1079078 was associated with a trend to higher logED50 in each race and in the combined cohort (P=0.011). Neither variant accounted for the ethnic differences in response. None of the ADRA1A haplotypes was associated with the outcomes. In conclusion, ADRA1A variants do not contribute substantially to the marked interindividual variability or ethnic differences in phenylephrine-mediated venoconstriction.

Inclusion of Underserved Racial and Ethnic Groups in Cancer Intervention Research Using New Media: A Systematic Literature Review

An increasing number of behavioral and psychosocial cancer interventions incorporate new media elements that are digital, networked, and interactive. However, it is unclear to what extent new media is being leveraged to benefit underserved racial and ethnic groups who disproportionately bear the burden of cancer. This inquiry is timely in light of growing evidence that these groups are receptive to new media. A systematic literature review was conducted to assess the inclusion of these groups in research on cancer-related new media interventions and use of new media to reduce racial and ethnic cancer disparities. A systematic search of three databases was conducted for articles published between January 2000 and March 2012 that presented studies of user experience with a behavioral or psychosocial cancer-related intervention with at least one new media component. Thirty-six articles were included in the final review. In about one-quarter of the studies, less than 20% of participants were African American, Latino, Asian American, or American Indian. In less than 10% of the studies, 80% or more of the samples were members of the aforementioned groups. Almost one-third of the studies reviewed were categorized as disparity focused but limited data were available on racial and ethnic differences in responses to new media interventions. Findings suggest that the promise and potential of new media cancer interventions are largely unrealized among the underserved. Additional research is needed to investigate a wide range of issues related to the development and delivery of such interventions in diverse racial and ethnic groups.