Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis - A EUFOREA-ARIA-EPOS-AIRWAYS ICP statement
Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis - A EUFOREA-ARIA-EPOS-AIRWAYS ICP statement
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DOI：
10.1111/all.13162
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发表时间：
2017-09-01
期刊：
影响因子：
12.4
通讯作者：
Bousquet, J.
中科院分区：
文献类型：
--
作者：
Hellings, P. W.;Fokkens, W. J.;Bousquet, J.
精准医疗（PM）越来越被认为是优化患者护理的前进方向。在肿瘤学领域，它现在被认为是其他医学领域的主要兴趣，如过敏和慢性气道疾病，面临着迫切需要提高疾病控制水平，提高患者满意度和提高预防干预的有效性。个性化护理、预测治疗成功、预防疾病和患者参与制定治疗计划相结合，预计将大大改善患有慢性残疾的个人的治疗方法。鉴于患者分层对治疗结果影响的新数据，欧洲和美国监管机构支持PM原则及其相对于当前治疗策略的潜在优势。本文件的目的是就PM在现有成人变应性鼻炎（AR）和慢性鼻窦炎（CRS）治疗算法中的地位和逐步实施原则提出共识。在诊断时，可以实现对初始治疗成功的预测和患者参与治疗计划的决策。理想的第二级方法包括预防疾病进展的策略，除了预测治疗的成功，以及患者参与长期治疗策略。内源性类型驱动治疗是个性化治疗方法的一部分，考虑到其实施所需的努力以及分子诊断和生物治疗的高成本，内源性类型驱动治疗应定位于三级护理。
Precision medicine (PM) is increasingly recognized as the way forward for optimizing patient care. Introduced in the field of oncology, it is now considered of major interest in other medical domains like allergy and chronic airway diseases, which face an urgent need to improve the level of disease control, enhance patient satisfaction and increase effectiveness of preventive interventions. The combination of personalized care, prediction of treatment success, prevention of disease and patient participation in the elaboration of the treatment plan is expected to substantially improve the therapeutic approach for individuals suffering from chronic disabling conditions. Given the emerging data on the impact of patient stratification on treatment outcomes, European and American regulatory bodies support the principles of PM and its potential advantage over current treatment strategies. The aim of the current document was to propose a consensus on the position and gradual implementation of the principles of PM within existing adult treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS). At the time of diagnosis, prediction of success of the initiated treatment and patient participation in the decision of the treatment plan can be implemented. The second-level approach ideally involves strategies to prevent progression of disease, in addition to prediction of success of therapy, and patient participation in the long-term therapeutic strategy. Endotype-driven treatment is part of a personalized approach and should be positioned at the tertiary level of care, given the efforts needed for its implementation and the high cost of molecular diagnosis and biological treatment.