Skip to main content
NCBI home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2002 Oct;94(10 Suppl):1–26.

Racial and ethnic differences in response to medicines: towards individualized pharmaceutical treatment.

Valentine J Burroughs 1, Randall W Maxey 1, Richard A Levy 1
PMCID: PMC2594139  PMID: 12401060

Abstract

It is now well documented that substantial disparities exist in the quality and quantity of medical care received by minority Americans, especially those of African, Asian and Hispanic heritage. In addition, the special needs and responses to pharmaceutical treatment of these groups have been undervalued or ignored. This article reviews the genetic factors that underlie varying responses to medicines observed among different ethnic and racial groups. Pharmacogenetic research in the past few decades has uncovered significant differences among racial and ethnic groups in the metabolism, clinical effectiveness, and side-effect profiles of many clinically important drugs. These differences must be taken into account in the design of cost management policies such as formulary implementation, therapeutic substitution and step-care protocols. These programs should be broad and flexible enough to enable rational choices and individualized treatment for all patients, regardless of race or ethnic origin.

Full text

PDF
1

Images in this article

11Figure 3
on p.11

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bach P. B., Cramer L. D., Warren J. L., Begg C. B. Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999 Oct 14;341(16):1198–1205. doi: 10.1056/NEJM199910143411606. [DOI] [PubMed] [Google Scholar]
  2. Baker Emma H., Duggal Ajay, Dong Yanbin, Ireson Nicola J., Wood Monique, Markandu Nirmala D., MacGregor Graham A. Amiloride, a specific drug for hypertension in black people with T594M variant? Hypertension. 2002 Jul;40(1):13–17. doi: 10.1161/01.hyp.0000022570.02119.75. [DOI] [PubMed] [Google Scholar]
  3. Bech-Thomsen N., Angelo H. R., Wulf H. C. Skin pigmentation as a predictor of minimal phototoxic dose after oral methoxsalen. Arch Dermatol. 1994 Apr;130(4):464–468. [PubMed] [Google Scholar]
  4. Bernabei R., Gambassi G., Lapane K., Landi F., Gatsonis C., Dunlop R., Lipsitz L., Steel K., Mor V. Management of pain in elderly patients with cancer. SAGE Study Group. Systematic Assessment of Geriatric Drug Use via Epidemiology. JAMA. 1998 Jun 17;279(23):1877–1882. doi: 10.1001/jama.279.23.1877. [DOI] [PubMed] [Google Scholar]
  5. Chrysant S. G., Brown R. D., Kem D. C., Brown J. L. Antihypertensive and metabolic effects of a new converting enzyme inhibitor, enalapril. Clin Pharmacol Ther. 1983 Jun;33(6):741–746. doi: 10.1038/clpt.1983.101. [DOI] [PubMed] [Google Scholar]
  6. Cushman W. C., Reda D. J., Perry H. M., Williams D., Abdellatif M., Materson B. J. Regional and racial differences in response to antihypertensive medication use in a randomized controlled trial of men with hypertension in the United States. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. Arch Intern Med. 2000 Mar 27;160(6):825–831. doi: 10.1001/archinte.160.6.825. [DOI] [PubMed] [Google Scholar]
  7. Dahlöf Björn, Devereux Richard B., Kjeldsen Sverre E., Julius Stevo, Beevers Gareth, de Faire Ulf, Fyhrquist Frej, Ibsen Hans, Kristiansson Krister, Lederballe-Pedersen Ole. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002 Mar 23;359(9311):995–1003. doi: 10.1016/S0140-6736(02)08089-3. [DOI] [PubMed] [Google Scholar]
  8. Evans W. E., Relling M. V. Pharmacogenomics: translating functional genomics into rational therapeutics. Science. 1999 Oct 15;286(5439):487–491. doi: 10.1126/science.286.5439.487. [DOI] [PubMed] [Google Scholar]
  9. Exner D. V., Dries D. L., Domanski M. J., Cohn J. N. Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction. N Engl J Med. 2001 May 3;344(18):1351–1357. doi: 10.1056/NEJM200105033441802. [DOI] [PubMed] [Google Scholar]
  10. Fiscella K., Franks P., Gold M. R., Clancy C. M. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000 May 17;283(19):2579–2584. doi: 10.1001/jama.283.19.2579. [DOI] [PubMed] [Google Scholar]
  11. Flack J. M., Mensah G. A., Ferrario C. M. Using angiotensin converting enzyme inhibitors in African-American hypertensives: a new approach to treating hypertension and preventing target-organ damage. Curr Med Res Opin. 2000;16(2):66–79. [PubMed] [Google Scholar]
  12. Flack J. M., Saunders E., Gradman A., Kraus W. E., Lester F. M., Pratt J. H., Alderman M., Green S., Vargas R., Espenshade M. Antihypertensive efficacy and safety of losartan alone and in combination with hydrochlorothiazide in adult African Americans with mild to moderate hypertension. Clin Ther. 2001 Aug;23(8):1193–1208. doi: 10.1016/s0149-2918(01)80101-6. [DOI] [PubMed] [Google Scholar]
  13. Freeman H. P., Payne R. Racial injustice in health care. N Engl J Med. 2000 Apr 6;342(14):1045–1047. doi: 10.1056/NEJM200004063421411. [DOI] [PubMed] [Google Scholar]
  14. Gibbs C. R., Beevers D. G., Lip G. Y. The management of hypertensive disease in black patients. QJM. 1999 Apr;92(4):187–192. doi: 10.1093/qjmed/92.4.187. [DOI] [PubMed] [Google Scholar]
  15. Goodman C., Rosendorff C., Coull A. Comparison of the antihypertensive effect of enalapril and propranolol in black South Africans. S Afr Med J. 1985 Apr 27;67(17):672–676. [PubMed] [Google Scholar]
  16. Kalow W. Ethnic differences in drug metabolism. Clin Pharmacokinet. 1982 Sep-Oct;7(5):373–400. doi: 10.2165/00003088-198207050-00001. [DOI] [PubMed] [Google Scholar]
  17. Kalow W. Pharmacoanthropology: outline, problems, and the nature of case histories. Fed Proc. 1984 May 15;43(8):2314–2318. [PubMed] [Google Scholar]
  18. Kleinman A., Eisenberg L., Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978 Feb;88(2):251–258. doi: 10.7326/0003-4819-88-2-251. [DOI] [PubMed] [Google Scholar]
  19. Kleyn P. W., Vesell E. S. Genetic variation as a guide to drug development. Science. 1998 Sep 18;281(5384):1820–1821. doi: 10.1126/science.281.5384.1820. [DOI] [PubMed] [Google Scholar]
  20. Kligman A. M., Kaidbey K. H. Phototoxicity to benoxaprofen. Eur J Rheumatol Inflamm. 1982;5(2):124–137. [PubMed] [Google Scholar]
  21. Lang C. C., Stein C. M., Brown R. M., Deegan R., Nelson R., He H. B., Wood M., Wood A. J. Attenuation of isoproterenol-mediated vasodilatation in blacks. N Engl J Med. 1995 Jul 20;333(3):155–160. doi: 10.1056/NEJM199507203330304. [DOI] [PubMed] [Google Scholar]
  22. Lawson W. B. Clinical issues in the pharmacotherapy of African-Americans. Psychopharmacol Bull. 1996;32(2):275–281. [PubMed] [Google Scholar]
  23. Lieberman J. A., Yunis J., Egea E., Canoso R. T., Kane J. M., Yunis E. J. HLA-B38, DR4, DQw3 and clozapine-induced agranulocytosis in Jewish patients with schizophrenia. Arch Gen Psychiatry. 1990 Oct;47(10):945–948. doi: 10.1001/archpsyc.1990.01810220061007. [DOI] [PubMed] [Google Scholar]
  24. Linder M. W., Prough R. A., Valdes R., Jr Pharmacogenetics: a laboratory tool for optimizing therapeutic efficiency. Clin Chem. 1997 Feb;43(2):254–266. [PubMed] [Google Scholar]
  25. Lindholm Lars H., Ibsen Hans, Dahlöf Björn, Devereux Richard B., Beevers Gareth, de Faire Ulf, Fyhrquist Frej, Julius Stevo, Kjeldsen Sverre E., Kristiansson Krister. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002 Mar 23;359(9311):1004–1010. doi: 10.1016/S0140-6736(02)08090-X. [DOI] [PubMed] [Google Scholar]
  26. Luzzatto L., Notaro R. Malaria. Protecting against bad air. Science. 2001 Jul 20;293(5529):442–443. doi: 10.1126/science.1063292. [DOI] [PubMed] [Google Scholar]
  27. Meyer U. A., Zanger U. M. Molecular mechanisms of genetic polymorphisms of drug metabolism. Annu Rev Pharmacol Toxicol. 1997;37:269–296. doi: 10.1146/annurev.pharmtox.37.1.269. [DOI] [PubMed] [Google Scholar]
  28. Moore R. D., Stanton D., Gopalan R., Chaisson R. E. Racial differences in the use of drug therapy for HIV disease in an urban community. N Engl J Med. 1994 Mar 17;330(11):763–768. doi: 10.1056/NEJM199403173301107. [DOI] [PubMed] [Google Scholar]
  29. Morrison R. S., Wallenstein S., Natale D. K., Senzel R. S., Huang L. L. "We don't carry that"--failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics. N Engl J Med. 2000 Apr 6;342(14):1023–1026. doi: 10.1056/NEJM200004063421406. [DOI] [PubMed] [Google Scholar]
  30. Owens K., King M. C. Genomic views of human history. Science. 1999 Oct 15;286(5439):451–453. doi: 10.1126/science.286.5439.451. [DOI] [PubMed] [Google Scholar]
  31. Poolsup N., Li Wan Po A., Knight T. L. Pharmacogenetics and psychopharmacotherapy. J Clin Pharm Ther. 2000 Jun;25(3):197–220. doi: 10.1046/j.1365-2710.2000.00281.x. [DOI] [PubMed] [Google Scholar]
  32. Prisant L. M., Mensah G. A. Use of beta-adrenergic receptor blockers in blacks. J Clin Pharmacol. 1996 Oct;36(10):867–873. doi: 10.1002/j.1552-4604.1996.tb04752.x. [DOI] [PubMed] [Google Scholar]
  33. Rana B. K., Hewett-Emmett D., Jin L., Chang B. H., Sambuughin N., Lin M., Watkins S., Bamshad M., Jorde L. B., Ramsay M. High polymorphism at the human melanocortin 1 receptor locus. Genetics. 1999 Apr;151(4):1547–1557. doi: 10.1093/genetics/151.4.1547. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Richardson A. D., Piepho R. W. Effect of race on hypertension and antihypertensive therapy. Int J Clin Pharmacol Ther. 2000 Feb;38(2):75–79. doi: 10.5414/cpp38075. [DOI] [PubMed] [Google Scholar]
  35. Saunders E., Curry C., Hinds J., Kong B. W., Medakovic M., Poland M., Roper K. Labetalol compared with propranolol in the treatment of black hypertensive patients. J Clin Hypertens. 1987 Sep;3(3):294–302. [PubMed] [Google Scholar]
  36. Saunders E. Drug treatment considerations for the hypertensive black patient. J Fam Pract. 1988 Jun;26(6):659–664. [PubMed] [Google Scholar]
  37. Saunders E., Weir M. R., Kong B. W., Hollifield J., Gray J., Vertes V., Sowers J. R., Zemel M. B., Curry C., Schoenberger J. A comparison of the efficacy and safety of a beta-blocker, a calcium channel blocker, and a converting enzyme inhibitor in hypertensive blacks. Arch Intern Med. 1990 Aug;150(8):1707–1713. [PubMed] [Google Scholar]
  38. Schneider E. C., Leape L. L., Weissman J. S., Piana R. N., Gatsonis C., Epstein A. M. Racial differences in cardiac revascularization rates: does "overuse" explain higher rates among white patients? Ann Intern Med. 2001 Sep 4;135(5):328–337. doi: 10.7326/0003-4819-135-5-200109040-00009. [DOI] [PubMed] [Google Scholar]
  39. Schwartz R. S. Racial profiling in medical research. N Engl J Med. 2001 May 3;344(18):1392–1393. doi: 10.1056/NEJM200105033441810. [DOI] [PubMed] [Google Scholar]
  40. Shapiro M. F., Morton S. C., McCaffrey D. F., Senterfitt J. W., Fleishman J. A., Perlman J. F., Athey L. A., Keesey J. W., Goldman D. P., Berry S. H. Variations in the care of HIV-infected adults in the United States: results from the HIV Cost and Services Utilization Study. JAMA. 1999 Jun 23;281(24):2305–2315. doi: 10.1001/jama.281.24.2305. [DOI] [PubMed] [Google Scholar]
  41. Siest G., Bertrand P., Herbeth B., Vincent-Viry M., Schiele F., Sass C., Visvikis S. Apolipoprotein E polymorphisms and concentration in chronic diseases and drug responses. Clin Chem Lab Med. 2000 Sep;38(9):841–852. doi: 10.1515/CCLM.2000.122. [DOI] [PubMed] [Google Scholar]
  42. Strickland T. L., Ranganath V., Lin K. M., Poland R. E., Mendoza R., Smith M. W. Psychopharmacologic considerations in the treatment of black American populations. Psychopharmacol Bull. 1991;27(4):441–448. [PubMed] [Google Scholar]
  43. Tai-Seale M., Freund D., LoSasso A. Racial disparities in service use among Medicaid beneficiaries after mandatory enrollment in managed care: a difference-in-differences approach. Inquiry. 2001 Spring;38(1):49–59. doi: 10.5034/inquiryjrnl_38.1.49. [DOI] [PubMed] [Google Scholar]
  44. Townsend R. R., DiPette D. J., Goodman R., Blumfield D., Cronin R., Gradman A., Katz L. A., McCarthy E. P., Sopko G. Combined alpha/beta-blockade versus beta 1-selective blockade in essential hypertension in black and white patients. Clin Pharmacol Ther. 1990 Dec;48(6):665–675. doi: 10.1038/clpt.1990.210. [DOI] [PubMed] [Google Scholar]
  45. Tseng C., Hoffman B., Kurimoto I., Shimizu T., Schmieder G. J., Taylor J. R., Streilein J. W. Analysis of effects of ultraviolet B radiation on induction of primary allergic reactions. J Invest Dermatol. 1992 Jun;98(6):871–875. doi: 10.1111/1523-1747.ep12457913. [DOI] [PubMed] [Google Scholar]
  46. Turbay D., Lieberman J., Alper C. A., Delgado J. C., Corzo D., Yunis J. J., Yunis E. J. Tumor necrosis factor constellation polymorphism and clozapine-induced agranulocytosis in two different ethnic groups. Blood. 1997 Jun 1;89(11):4167–4174. [PubMed] [Google Scholar]
  47. Vesell E. S. The influence of host factors on drug response. I. Ethnic background. Ration Drug Ther. 1979 Aug;13(8):1–7. [PubMed] [Google Scholar]
  48. Weber W. W. Populations and genetic polymorphisms. Mol Diagn. 1999 Dec;4(4):299–307. doi: 10.154/MODI00400299. [DOI] [PubMed] [Google Scholar]
  49. Wolf C. R., Smith G. Pharmacogenetics. Br Med Bull. 1999;55(2):366–386. doi: 10.1258/0007142991902439. [DOI] [PubMed] [Google Scholar]
  50. Wood A. J., Zhou H. H. Ethnic differences in drug disposition and responsiveness. Clin Pharmacokinet. 1991 May;20(5):350–373. doi: 10.2165/00003088-199120050-00002. [DOI] [PubMed] [Google Scholar]
  51. Xie H. G., Kim R. B., Wood A. J., Stein C. M. Molecular basis of ethnic differences in drug disposition and response. Annu Rev Pharmacol Toxicol. 2001;41:815–850. doi: 10.1146/annurev.pharmtox.41.1.815. [DOI] [PubMed] [Google Scholar]
  52. Yancy C. W., Fowler M. B., Colucci W. S., Gilbert E. M., Bristow M. R., Cohn J. N., Lukas M. A., Young S. T., Packer M., U.S. Carvedilol Heart Failure Study Group Race and the response to adrenergic blockade with carvedilol in patients with chronic heart failure. N Engl J Med. 2001 May 3;344(18):1358–1365. doi: 10.1056/NEJM200105033441803. [DOI] [PubMed] [Google Scholar]
  53. Zhou H. H., Liu Z. Q. Ethnic differences in drug metabolism. Clin Chem Lab Med. 2000 Sep;38(9):899–903. doi: 10.1515/CCLM.2000.131. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES