ASTHMA CLINICAL RESEARCH NETWORK

这项申请建议继续调查人员的参与 在托马斯·杰斐逊大学由六个中心组成的互动网络中 (哮喘临床研究网络或ACRN)进行研究 哮喘的新治疗方法和传播研究结果 为练习界干杯。有人建议建立这样一个网络。 流行病学数据显示死亡率、发病率、 通过临床和基础研究得出的哮喘患病率和成本 表明哮喘与呼吸道炎症有关，而且 发展速度加快，潜力大，但也 治疗哮喘的费用可能很高。确定这些产品的位置 治疗被认为需要合作的多中心研究 考察了反映美国多样性的大量主题。 人口。 在最初的5年里，ACRN建立了一个基础设施，以满足 这一需要，并在纽约哈莱姆医院增加了另一个中心， 服务于以少数族裔为主的人群。ACRN有 常规使用β-激动剂对轻度高血压患者影响的已完成研究 哮喘(袋)和抗炎药的疗效， 秋水仙碱，作为吸入性皮质类固醇的替代药物 哮喘。现在正在进行另外两项试验，比较这些试验的效果。 一种长效β-激动剂，一种吸入皮质类固醇，以及 两者的结合改变了临床和生理结果， 以及中、重度哮喘患者的呼吸道炎症。第五项研究， 确定不同吸入皮质类固醇的当量剂量 对皮质醇分泌的影响，迫在眉睫。也完成了试验 作为10-12项辅助研究旨在改善 临床研究已在ATS、ACCP和 啊啊呀。到目前为止，这些研究中的三项已发表在Peer- 审阅了期刊。ACRN还报告了一个小组的结果 对袋子研究中的受试者的分析表明，患有 不同的β-肾上腺素能受体基因型别不同 受常规使用沙丁胺醇的影响。 这项申请建议杰斐逊继续参与 参与ACRN的多中心协作试验。建议 研究包括对不同剂量的药物的疗效进行比较 吸入的皮质类固醇具有相同的全身影响(从 如上所述的研究)，这是一项关于 吸入型β-激动剂在按分层的受试者中的常规使用 β-肾上腺素能受体的基因分型及其疗效研究 白三烯途径拮抗剂使还原或消除成为可能 轻度或中度持续性受试者吸入皮质类固醇的情况 哮喘。还简要讨论了其他计划中的研究，以及 理解它们可以被修改或替换以响应新的 信息、新疗法或不断变化的临床研究重点。

This application proposes to continue the participation of investigators at Thomas Jefferson University in an interactive network of six centers (the Asthma Clinical Research Network or ACRN ) in conducting studies of novel therapeutic approaches to asthma and in disseminating findings to the practicing community. The need for such a network was suggested by epidemiological data showing increases in mortality, morbidity, prevalence, and costs of asthma, by clinical and basic research studies showing that asthma is linked to inflammation in the airways, and by the accelerating rate of development of potentially effective, but also potentially costly treatments for asthma. Defining the place of these therapies was seen as requiring collaborative, multi-center studies examining large numbers of subjects reflecting the diversity of the U.S. population. In its first 5 years, the ACRN established an infrastructure to meet this need and has added another center at Harlem Hospital in New York, which serves a predominantly minority population. The ACRN has completed studies of the effects of regular beta-agonist use in mild asthma ( BAGS ) and of the efficacy of the anti-inflammatory agent, colchicine, as an alternative to an inhaled corticosteroid in moderate asthma. Now underway are two additional trials comparing the effects of a long-acting beta-agonist, an inhaled corticosteriod, and the combination of the two in altering clinical and physiologic outcomes, and airway inflammation in moderate or severe asthma. A fifth study, establishing doses of different inhaled corticosteroids with equivalent effects on cortisol secretion, is imminent. Completed trials as well as 10-12 ancillary studies designed to improve the performance of clinical research have been presented at meetings of the ATS, ACCP, and AAAAI. Three of these studies have thus far been published in peer- reviewed journals. The ACRN has also reported the results of a subgroup analysis of subjects in the BAGS study showing that subjects with different genotypes for the beta-adrenergic receptor are differently affected by regular use of albuterol. This application proposes continued participation of the Jefferson Center in the multicentered, collaborative trials of the ACRN. Proposed studies include a comparison of the efficacy of doses of different inhaled corticosteriods with equal systemic effects (as estimated from the study described above), a prospective study of the effects of regular use of an inhaled beta-agonist in subjects stratified by genotype for the beta-adrenergic receptor, and a study of the efficacy of a leukotriene pathway antagonist in enabling reduction or elimination of inhaled corticosteriods in subjects with mild or moderate persistent asthma. Other planned studies are also briefly discussed, with the understanding that they could be modified or replaced in response to new information, new therapies, or changing clinical research priorities.