Pharmacogenetics in cardiovascular diseases therapy – treatment according guidelines or according the individual requirement?
Authors:
Jan Bultas
Authors‘ workplace:
Univerzita Karlova V Praze, 3. lékařská fakulta, Ústav farmakologie
Published in:
Čas. Lék. čes. 2010; 149: 476-481
Category:
Review Article
Overview
In clinical practice the individual response to a drug represents a great problem. Many of us experienced a situation when the drug effect declined or drug-related toxic reaction occurred. The typical example is the variation of optimal warfarin dosage. The main cause of interindividual differences in the drug response is the polymorphism in drug resorption and elimination systems, enzymes responsible for drug biotransformation, target receptors or signal molecules. The individualized drug therapy requires physicians to be oriented in main causes of pharmacokinetic and pharmacodynamic variations and be able to predict accurately the individual drug response.
Key words:
polymorphism, clopidogrel, warfarin, betablockers, drug metabolism, transport protein, pharmacogenetics.
Sources
1. Chew DP, et al. Six-month survival benefits associated with clinical guideline recommendations in acute coronary syndromes, Heart published online June 7, 2010.
2. Hoffmeyer S, et al. Functional polymorphisms of the human multidrug-resistance gene: multiple sequence variations and correlation of one allele with P glycoprotein expression and activity in vivo. Proc Natl Acad Sci USA 2000; 97: 3473–3478.
3. Simon T, et al. French Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) Investigators: Genetic determinants of response to clopidogrel and cardiovascular events. N Engl J Med 2009; 360(4): 363–375.
4. Mega JL, et al. Genetic variants in ABCB1 and CYP2C19 and cardiovascular outcomes after treatment with clopidogrel and prasugrel in the TRITON-TIMI 38 trial: a pharmacogenetic analysis. The Lancet, Early Online Publication, 29 August 2010.
5. Mega JL, et al. Cytochrome P-450 Polymorphisms and Response to Clopidogrel. N Engl J Med 2009; 360(4): 411–413.
6. Paré G, et al. Effects of CYP2C19 genotype on clopidogrel treatment in CURE and ACTIVE. N Eng J Med 2010; Early Online Publication August 2010.
7. Bellemain-Appaix A, et al: New P2Y12 inhibitors versus clopidogrel in percutaneous coronary intervention. J Am Coll Cardiol 2010; Early Online Publ., 30 August 2010.
8. Motovska Z, et al. Platelet gene polymorphisms and risk of bleeding in patients undergoing elective coronary angiography: Agenetic substudy of the PRAGUE-8 trial, Atherosclerosis 2010, journal homepage: www.elsevier.com/locate/athero sclerosis.
9. Jazwinska-Tarnawska E, et al. The influence of CYP2D6 polymorphism on the antiarrhythmic efficacy of propafenone in patients with paroxysmal atrial fibrillation during 3 months propafenone prophylactic treatment. Int J Clin Pharmacol Ther 2001; 39(7): 288–292.
10. Seeringer A, et al. Enantiospecific pharmacokinetics of metoprolol in CYP2D6 ultra-rapid metabolizers and correlation with exercise-induced heart rate. Eur J Clin Pharmacol 2008; 64(9): 883–888.
11. Kirchheiner J, et al. Impact of the ultrarapid metabolizer genotype of cytochrome P450 2D6 on metoprolol Pharmacokinetics and Pharmacodynamics*Impact of the ultrarapid metabolizer genotype of Cytochrome P450 2D6 on metoprolol Pharmacokinetics and Pharmacodynamics, Clinical Pharmacology & Therapeutics 76, 302–312.
12. Wuttke H, et al. Increased frequency of cytochrome P450 2D6 poor metabolizers among patients with metoprolol-associated adverse effects. Clin Pharmacol Ther 2002; 72(4): 429–437.
13. Moyer TP, et al. Warfarin sensitivity genotyping: a review of the literature and summary of patient experience. Mayo Clin Proc 2009; 84(12): 1079–1094.
14. King CR, et al. Gamma-glutamyl carboxylase and its influence on warfarin dose. Thromb Haemost 20105; 104(4).
15. Yang L, et al. Impact of VKORC1 gene polymorphism on interindividual and interethnic warfarin dosage requirement- A systematic review and meta analysis. Thromb Res., Early Online Publication 2009 Nov 24.
16. Moyer TP, et al. Warfarin sensitivity genotyping: a review of the literature and summary of patient experience. Mayo Clin Proc 2009; 84(12): 1079–1094.
17. Wang B, et al. Genetic Polymorphism of the Human Cytochrome P450 2C9 Gene and Its Clinical Significance. Curr Drug Metab 2009; 10(7): 781–834.
18. Small KM, et al. Synergistic polymorphisms of beta1- and alpha2C-adrenergic receptors and the risk of congestive heart failure. N Engl J Med 2002; 347(15): 1135–1142.
19. Sconce EA, et al. The impact of CYP2C9 and VKORC1 genetic polymorphism and patient characteristics upon warfarin dose requirements: proposal for a new dosing regimen. Blood 2005; 106(7): 2329–2333.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistArticle was published in
Journal of Czech Physicians
Most read in this issue
- Significance of TDM, phenotyping and genotyping for the correct drug dosage
- Hereditary thrombophilias – recommendations for genetic testing in the clinical praxis
- Pharmacogenetic aspects of current pharmacotherapy
- Pharmacogenetics in cardiovascular diseases therapy – treatment according guidelines or according the individual requirement?