Precision Medicine and Heterogeneity of Treatment Effect in Therapies for ARDS

• Published in: Chest Vol. 160; no. 5; pp. 1729 - 1738
• Main Authors: Khan, Yasin A., Fan, Eddy, Ferguson, Niall D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; American College of Chest Physicians
• Subjects: acute respiratory failure; ARDS; Biological Variation, Population; Critical Care: CHEST Reviews; Genetic Heterogeneity; heterogeneity of treatment effect; Humans; Precision Medicine - methods; Respiratory Distress Syndrome - genetics; Respiratory Distress Syndrome - therapy; Treatment Outcome; acute respiratory failure; LPV; HFOV; PEEP; VFD; heterogeneity of treatment effect; HTE; NMBA; ARDS
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1016/j.chest.2021.07.009

ARDS is a clinically heterogeneous syndrome, rather than a distinct disease. This heterogeneity at least partially explains the difficulty in studying treatments for these patients and contributes to the numerous trials of therapies for the syndrome that have not shown benefit. Recent studies have identified different subphenotypes within the heterogeneous patient population. These different subphenotypes likely have variable clinical responses to specific therapies, a concept known as heterogeneity of treatment effect. Recognizing different subphenotypes and heterogeneity of treatment effect has important implications for the clinical management of patients with ARDS. This review presents studies that have identified different subphenotypes and discusses how they can modify the effects of therapies evaluated in trials that are commonly considered to have shown no overall benefit in patients with ARDS.