Ethnicity Caucasian

Ethnicity Caucasian Caucasian Caucasian African-American, Asians, Hispanics Most common in Caucasians, rare in dark-skinned people Most common in African descendants... 

Calcium deposition (pg/scaffold) is quantified after 14 days for three different age (36-50), gender (female) and ethnicity (Caucasian) matched hASC lines growing on bicomponent and monocomponent scaffolds. Standard error bars reflect variability in the estimate of the mean. Scaffold type is significant at a level of p = 0.03 when calcium deposition is averaged over all three cell lines. Reprinted with permission from reference 67. Copyright 2011 Taylor Francis Group. 

Over 66.8 million people worldwide have glaucoma, making it the second leading cause of blindness worldwide.1 In the United States it is estimated that 2.22 million people are affected by POAG, and by 2020 this number will increase to 3.36 million. The prevalence varies with race and ethnicity and it is 3 to 5 times more prevalent in African-Americans than Caucasians. The prevalence of POAG increases with age and is rarely seen in patients less than 40 years of age.2-4... 

Psoriasis is a common inflammatory skin disorder which is estimated to affect 1.5% to 3% of the Caucasian population.1,2 It may present at any age.3,4 Ethnic factors influence disease prevalence. In the United States, prevalence among blacks (0.45% to 0.7%) is lower than in the remainder of the United States population (1.4% to 4.6%).1 Between 10% and 30% of patients with psoriasis will also have psoriatic arthritis.5 In 10% to 15% of psoriatic patients with arthritis, joint symptoms actually appear prior to skin involvement.3 Clinical depression is another frequent comorbid illness in these patients. A recent United States survey showed that 8% to 10% of psoriatic patients aged 18 to 54 years old actively contemplated suicide because of their psoriasis.6... 

Generally, younger patients with a better performance status tolerate chemotherapy better than elderly patients. Caucasian women tend to have a worse prognosis and response to therapy compared with other ethnic backgrounds.2,4,5... 

Chiu et al, 1992 Lin Finder, 1983 Lin et al, 1988b Potkin et al, 1984 Lin etal., 1989 Ruiz et al, 1996 Jann et al, 1989 Jann etal, 1992 Zhang-Wong etal., 1998). The majority of these studies were carried out with haloperidol. A number of studies examined differences between Caucasians and Hispanics, and African Americans and Caucasians (Midha et al., 1988b Midha etal, 1988a Ruiz et al., 1996). In general these studies provided mixed results. Another noteworthy feature of the research literature is that there appear to be no studies that have considered ethnic differences in pharmacokinetics and response for the depot antipsychotics. This may be an artifact of the low levels of depot prescribing found in the US, China, and Japan. 

With respect to other ethnic groups, African Americans may have a differential sensitivity to weight gain on clozapine (de Leon etal, 2007). They may also require lower doses than Caucasians (Kelly et al, 2006) and inter-individual as well as ethnic responsiveness maybe partly explained by differences in dopamine receptor polymorphisms (Hwang et al, 2005). It is conceivable that side effects may also be differentially expressed based on pharmacodynamic differences resulting from polymorphisms in other receptor types (histaminergic, muscarinic, etc.). This area remains largely unexplored with respect to ethnic differences in antipsychotic side effects. 

Kinirons, M. T. el al. (1996). Triazolam pharmacokinetics and pharmacodynamics in Caucasians and Southern Asians ethnicity and CYP3A activity. Br. J. Clin. Pharmacol., 41, 69-72. 

Siffert, W., Forster, P., Jockel, K. H. etal. (1999). Worldwide ethnic distribution of the G protein beta3 subunit 825T allele and its association with obesity in Caucasian, Chinese, and Black African individuals. /. Am. Soc. Nephrol., 10, 1921-30. 

Research in psychopharmacology has shown that ethnicity must be considered in psychiatry as well (Lawson, 1986 Pi 8c Simpson, 2005). Early clinical trials with antipsychotic and antidepressant medications showed that ethnic minorities may respond when given the same doses as Caucasians, and may have more side effects (Lawson, 1986 Lawson, 1990). However, dosing cannot be used as a measure of appropriate pharmacotherapy because an extensive literature has shown that African Americans often receive higher doses of antipsychotics despite evidence of more side effects. 

Ethnic differences in CYP2D6 have been more thoroughly documented than with the other isoenzyme (Bradford, 2002). Over 70% of Caucasians but only about half of Asians, Sub-Saharan Africans, and African Americans have fully functional CYP2D6 alleles - alleles that code for normal metabolic activity. Approximately 50% of Asian and people of African ancestry have reduced function or nonfunctioning alleles. As a consequence, many older psychotropic medications are metabolized more slowly and plasma levels would be higher. Thus individuals of African and Asian ancestry would have an increased risk of side effects and should receive lower dose for a therapeutic response when compared to Caucasians of European descent (Lin, 2001 Lawson, 2000). 

These findings emphasize the importance of including ethnic minorities in clinical trials in sufficient numbers and to do intra-ethnic analysis. Failure to do so will mean that guidelines for new pharmacological products will be relevant mostly to treating Caucasians only. Ethnic minorities are left at risk for possible idiosyncratic side effects, inappropriate dosing, or lack of efficacy. 

---