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Biswas M, Sawajan N, Rungrotmongkol T, Sanachai K, Ershadian M, Sukasem C. Pharmacogenetics and Precision Medicine Approaches for the Improvement of COVID-19 Therapies. Front Pharmacol 2022; 13:835136. [PMID: 35250581 PMCID: PMC8894812 DOI: 10.3389/fphar.2022.835136] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/24/2022] [Indexed: 01/18/2023] Open
Abstract
Many drugs are being administered to tackle coronavirus disease 2019 (COVID-19) pandemic situations without establishing clinical effectiveness or tailoring safety. A repurposing strategy might be more effective and successful if pharmacogenetic interventions are being considered in future clinical studies/trials. Although it is very unlikely that there are almost no pharmacogenetic data for COVID-19 drugs, however, from inferring the pharmacokinetic (PK)/pharmacodynamic(PD) properties and some pharmacogenetic evidence in other diseases/clinical conditions, it is highly likely that pharmacogenetic associations are also feasible in at least some COVID-19 drugs. We strongly mandate to undertake a pharmacogenetic assessment for at least these drug–gene pairs (atazanavir–UGT1A1, ABCB1, SLCO1B1, APOA5; efavirenz–CYP2B6; nevirapine–HLA, CYP2B6, ABCB1; lopinavir–SLCO1B3, ABCC2; ribavirin–SLC28A2; tocilizumab–FCGR3A; ivermectin–ABCB1; oseltamivir–CES1, ABCB1; clopidogrel–CYP2C19, ABCB1, warfarin–CYP2C9, VKORC1; non-steroidal anti-inflammatory drugs (NSAIDs)–CYP2C9) in COVID-19 patients for advancing precision medicine. Molecular docking and computational studies are promising to achieve new therapeutics against SARS-CoV-2 infection. The current situation in the discovery of anti-SARS-CoV-2 agents at four important targets from in silico studies has been described and summarized in this review. Although natural occurring compounds from different herbs against SARS-CoV-2 infection are favorable, however, accurate experimental investigation of these compounds is warranted to provide insightful information. Moreover, clinical considerations of drug–drug interactions (DDIs) and drug–herb interactions (DHIs) of the existing repurposed drugs along with pharmacogenetic (e.g., efavirenz and CYP2B6) and herbogenetic (e.g., andrographolide and CYP2C9) interventions, collectively called multifactorial drug–gene interactions (DGIs), may further accelerate the development of precision COVID-19 therapies in the real-world clinical settings.
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Affiliation(s)
- Mohitosh Biswas
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
- Department of Pharmacy, University of Rajshahi, Rajshahi, Bangladesh
| | - Nares Sawajan
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
- Department of Pathology, School of Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Thanyada Rungrotmongkol
- Structural and Computational Biology Research Unit, Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
- Program in Bioinformatics and Computational Biology, Graduate School, Chulalongkorn University, Bangkok, Thailand
| | - Kamonpan Sanachai
- Structural and Computational Biology Research Unit, Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok, Thailand
| | - Maliheh Ershadian
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
- Pharmacogenomics and Precision Medicine, The Preventive Genomics and Family Check-up Services Center, Bumrungrad International Hospital, Bangkok, Thailand
- MRC Centre for Drug Safety Science, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- *Correspondence: Chonlaphat Sukasem,
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Marin JJG, Serrano MA, Monte MJ, Sanchez-Martin A, Temprano AG, Briz O, Romero MR. Role of Genetic Variations in the Hepatic Handling of Drugs. Int J Mol Sci 2020; 21:E2884. [PMID: 32326111 PMCID: PMC7215464 DOI: 10.3390/ijms21082884] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
The liver plays a pivotal role in drug handling due to its contribution to the processes of detoxification (phases 0 to 3). In addition, the liver is also an essential organ for the mechanism of action of many families of drugs, such as cholesterol-lowering, antidiabetic, antiviral, anticoagulant, and anticancer agents. Accordingly, the presence of genetic variants affecting a high number of genes expressed in hepatocytes has a critical clinical impact. The present review is not an exhaustive list but a general overview of the most relevant variants of genes involved in detoxification phases. The available information highlights the importance of defining the genomic profile responsible for the hepatic handling of drugs in many ways, such as (i) impaired uptake, (ii) enhanced export, (iii) altered metabolism due to decreased activation of prodrugs or enhanced inactivation of active compounds, and (iv) altered molecular targets located in the liver due to genetic changes or activation/downregulation of alternative/compensatory pathways. In conclusion, the advance in this field of modern pharmacology, which allows one to predict the outcome of the treatments and to develop more effective and selective agents able to overcome the lack of effect associated with the existence of some genetic variants, is required to step forward toward a more personalized medicine.
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Affiliation(s)
- Jose J. G. Marin
- HEVEFARM Group, Center for the Study of Liver and Gastrointestinal Diseases (CIBERehd), Carlos III National Institute of Health, University of Salamanca, IBSAL, 37007 Salamanca, Spain; (M.A.S.); (M.J.M.); (A.S.-M.); (A.G.T.); (O.B.); (M.R.R.)
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Singkham N, Avihingsanon A, Thammajaruk N, Ruxrungtham K, Bunupuradah T, Kiertiburanakul S, Chetchotisakd P, Burger DM, Emery S, Punyawudho B. Influence of CYP3A5 and SLCO1B1 polymorphisms on atazanavir/r concentrations in Thai HIV-infected patients. Pharmacogenomics 2020; 20:517-527. [PMID: 31124411 DOI: 10.2217/pgs-2018-0196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Aim: To evaluate the influence of genetic polymorphisms on plasma trough concentrations of atazanavir (ATV) and ritonavir (RTV). Patients & methods: The concentration-to-dose ratios were compared between different genotype groups of CYP3A5, ABCB1, SLCO1B1 and NR1I2 in 490 patients. Multiple regression analysis was used to examine the association between genetic and clinical factors and log-transformed concentration-to-dose ratio of ATV and RTV. Results: Higher concentrations of ATV and RTV were significantly associated with CYP3A5 6986 GG and SLCO1B1 521 TC or CC. Female patients had significantly higher ATV plasma concentration than male patients. Conclusion: Genetic polymorphisms and gender are factors affecting the variability of ATV and RTV concentrations in the Thai population. Thus, genetic testing is worth considering when atazanavir + low dose ritonavir is prescribed.
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Affiliation(s)
- Noppaket Singkham
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,PhD's Degree Program in Pharmacy, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Kiat Ruxrungtham
- HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Sasisopin Kiertiburanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - David M Burger
- Department of Pharmacy, Radbound University Medical Center, Nijmegen, The Netherlands
| | - Sean Emery
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Baralee Punyawudho
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology & Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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4
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Tamraz B, Huang Y, French AL, Kassaye S, Anastos K, Nowicki MJ, Gange S, Gustafson DR, Bacchetti P, Greenblatt RM, Hysi PG, Aouizerat BE. Association of Pharmacogenetic Markers With Atazanavir Exposure in HIV-Infected Women. Clin Pharmacol Ther 2020; 107:315-318. [PMID: 31562781 PMCID: PMC10810687 DOI: 10.1002/cpt.1605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/09/2019] [Indexed: 02/03/2023]
Abstract
SORCS2 rs73208473 was recently associated with decreased atazanavir (ATV) concentration in the hair of women with seropositive HIV. Herein, we report on a pharmacogenetic study of women with seropositive HIV demonstrating a similar association between rs73208473 and dose-adjusted plasma ATV concentration in African Americans.
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Affiliation(s)
- Bani Tamraz
- School of Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Yong Huang
- School of Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Audrey L. French
- Infectious Diseases, CORE Center/Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marek J. Nowicki
- Department of Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephen Gange
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York – Downstate Medical Center, Brooklyn, New York, USA
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Ruth M. Greenblatt
- School of Pharmacy, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Pirro G. Hysi
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, UK
- Great Ormand Street Institute for Child Health, University College London, London, UK
| | - Bradley E. Aouizerat
- Bluestone Center for Clinical Research, College of Dentistry, New York University, New York, New York, USA
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6
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Mallayasamy S, Penzak SR. Pharmacogenomic Considerations in the Treatment of HIV Infection. Pharmacogenomics 2019. [DOI: 10.1016/b978-0-12-812626-4.00008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tamraz B, Huang Y, French AL, Kassaye S, Anastos K, Nowicki MJ, Gange S, Gustafson DR, Bacchetti P, Greenblatt RM, Hysi PG, Aouizerat BE. A Genome-Wide Association Study Identifies a Candidate Gene Associated With Atazanavir Exposure Measured in Hair. Clin Pharmacol Ther 2018; 104:949-956. [PMID: 29315502 PMCID: PMC6037621 DOI: 10.1002/cpt.1014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/14/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022]
Abstract
Hair provides a direct measure of long-term exposure of atazanavir (ATV). We report the results of the first genome-wide association study (GWAS) of ATV exposure measured in hair in an observational cohort representative of US women living with HIV; the Women's Interagency HIV Study. Approximately 14.1 million single nucleotide polymorphisms (SNPs) were analyzed in linear regression-based GWAS, with replication, adjusted for nongenetic predictors collected under conditions of actual use of ATV in 398 participants. Lastly, the PharmGKB database was used to identify pharmacogene associations with ATV exposure. The rs73208473, within intron 1 of SORCS2, resulted in a 0.46-fold decrease in ATV exposure, with the strongest association (P = 1.71×10-8 ) in GWAS. A priori pharmacogene screening did not identify additional variants statistically significantly associated with ATV exposure, including those previously published in ATV plasma candidate pharmacogene studies. The findings demonstrate the potential value of pharmacogenomic GWAS in ethnically diverse populations under conditions of actual use.
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Affiliation(s)
- Bani Tamraz
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Yong Huang
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Audrey L. French
- Infectious Diseases, CORE Center/Stroger Hospital of Cook County, Chicago, IL
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, DC
| | - Kathryn Anastos
- Departments of Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Marek J. Nowicki
- Department of Medicine, University of Southern California, Los Angeles, CA
| | - Stephen Gange
- John Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Deborah R. Gustafson
- Department of Neurology, State University of New York - Downstate Medical Center, Brooklyn, NY
| | - Peter Bacchetti
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA
| | - Ruth M. Greenblatt
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA
| | - Pirro G. Hysi
- Department of Twin Research and Genetic Epidemiology, King’s College London, United Kingdom
- Great Ormand Street Institute for Child Health, University College London, United Kingdom
| | - Bradley E. Aouizerat
- Bluestone Center for Clinical Research, College of Dentistry, New York University, New York, NY
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Cusato J, Allegra S, Nicolò AD, Calcagno A, D'Avolio A. Precision medicine for HIV: where are we? Pharmacogenomics 2018; 19:145-165. [DOI: 10.2217/pgs-2017-0123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
To date, antiretroviral therapy is highly effective in HIV-affected patients, but the individualization of such a life-long therapy may be advised. This review briefly summarizes the main factors involved in the potential personalization of antiretroviral treatment. Relevant articles in English were identified by PubMed and recent congresses’ abstracts. Foremost influences concerning pharmacodynamics, therapeutic drug monitoring, pharmacogenetics, comorbidities, immune recovery and viral characteristics affecting the healthcare of HIV-positive patients are listed here. Furthermore, pharmacoeconomic aspects are mentioned. Applying pharmacokinetic and pharmacogenetic knowledge may be informative and guide the better choice of treatment in order to achieve long-term efficacy and avoid adverse events. Randomized investigations of the clinical relevance of tailored antiretroviral regimens are needed in order to obtain a better management of HIV/AIDS-affected patients.
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Affiliation(s)
- Jessica Cusato
- Department of Medical Sciences; University of Turin – ASL ‘Città di Torino’ Laboratory of Clinical Pharmacology and Pharmacogenetics; Amedeo di Savoia Hospital, Turin, Italy
| | - Sarah Allegra
- Department of Medical Sciences; University of Turin – ASL ‘Città di Torino’ Laboratory of Clinical Pharmacology and Pharmacogenetics; Amedeo di Savoia Hospital, Turin, Italy
| | - Amedeo De Nicolò
- Department of Medical Sciences; University of Turin – ASL ‘Città di Torino’ Laboratory of Clinical Pharmacology and Pharmacogenetics; Amedeo di Savoia Hospital, Turin, Italy
| | - Andrea Calcagno
- Department of Medical Sciences; University of Turin – ASL ‘Città di Torino’ Laboratory of Clinical Pharmacology and Pharmacogenetics; Amedeo di Savoia Hospital, Turin, Italy
| | - Antonio D'Avolio
- Department of Medical Sciences; University of Turin – ASL ‘Città di Torino’ Laboratory of Clinical Pharmacology and Pharmacogenetics; Amedeo di Savoia Hospital, Turin, Italy
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Chen J, Akhtari FS, Wagner MJ, Suzuki O, Wiltshire T, Motsinger-Reif AA, Dumond JB. Pharmacogenetic Analysis of the Model-Based Pharmacokinetics of Five Anti-HIV Drugs: How Does This Influence the Effect of Aging? Clin Transl Sci 2017; 11:226-236. [PMID: 29205871 PMCID: PMC5866997 DOI: 10.1111/cts.12525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/31/2017] [Indexed: 12/27/2022] Open
Abstract
Analysis of aging and pharmacogenetics (PGx) on antiretroviral pharmacokinetics (PKs) could inform precision dosing for older human HIV‐infected patients. Seventy‐four participants receiving either atazanavir/ritonavir (ATV/RTV) or efavirenz (EFV) with tenofovir/emtricitabine (TFV/FTC) provided PK and PGx information. Aging‐PGx‐PK association and interaction analyses were conducted using one‐way analysis of variance (ANOVA), multiple linear regression, and Random Forest ensemble methods. Our analyses associated unbound ATV disposition with multidrug resistance protein (MRP)4, RTV with P‐glycoprotein (P‐gp), and EFV with cytochrome P450 (CYP)2B6 and MRP4 genetic variants. The clearance and cellular distribution of TFV were associated with P‐gp, MRP2, and concentrative nucleoside transporters (CNTs), and FTC parameters were associated with organic cation transporters (OCTs) and MRP2 genetic variants. Notably, p16INK4a expression, a cellular aging marker, predicted EFV and FTC PK when genetic factors were adjusted. Both age and p16INK4a expression interacted with PGx on ATV and TFV disposition, implying potential dose adjustment based on aging may depend on genetic background.
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Affiliation(s)
- Jingxian Chen
- University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Farida S Akhtari
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA.,Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA
| | - Michael J Wagner
- University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Oscar Suzuki
- University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tim Wiltshire
- University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison A Motsinger-Reif
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA.,Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | - Julie B Dumond
- University of North Carolina Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Calcagno A, Cusato J, D'Avolio A, Bonora S. Genetic Polymorphisms Affecting the Pharmacokinetics of Antiretroviral Drugs. Clin Pharmacokinet 2017; 56:355-369. [PMID: 27641153 DOI: 10.1007/s40262-016-0456-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antiretroviral treatment is highly effective in enhancing HIV-positive patients' survival and quality of life. Despite an increased tolerability in recent years, a substantial amount of patients experience side effects. Antiretrovirals' efficacy and tolerability have been associated with plasma concentrations and single nucleotide polymorphisms in selected genes involved in drug disposition. OBJECTIVE Our aim was to review the current knowledge in genetic polymorphisms affecting plasma, intracellular or compartmental concentrations of antiretrovirals. METHODS A search of the PubMed database was conducted to identify relevant articles, using the following terms: 'pharmacogenetics' or 'pharmacogenomics' or 'single nucleotide polymorphisms' or 'genetic/allelic variants' and 'pharmacokinetics' or 'concentrations' and 'HIV' or 'antiretroviral'. Abstracts from the main HIV conferences during 2015 and 2016 were also searched using the same keywords. Abstracts were manually checked and, if relevant, full papers were obtained. Only articles published in English were selected. RESULTS Several genetic polymorphisms in genes coding enzymes involved in drug metabolism (cytochrome P450 isoenzymes and uridine diphosphate glucuronosyltransferases) and transport (P-glycoprotein, anionic and cationic transporters, other transporters), as well as nuclear receptors (pregnane X receptor and the constitutive androstane receptor), have been associated with concentrations of antiretrovirals. The extent of such influence, the conflicting data, and the potential clinical relevance are discussed in the main section of this article. CONCLUSION Genetic polymorphisms may affect antiretroviral disposition, as well as both efficacy and toxicity. Despite a large amount of data, such precious knowledge has seldom been applied in patients. Studies on the clinical relevance and cost effectiveness of tailoring antiretroviral regimens to patients' genetic assets are lacking, but their importance may grow with the increasing age and complexity of persons living with HIV/AIDS.
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Affiliation(s)
- Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy.
| | - Jessica Cusato
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy
| | - Antonio D'Avolio
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, c/o Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy
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Harris M, Ganase B, Watson B, Hull MW, Guillemi SA, Zhang W, Saeedi R, Harrigan PR. Efficacy and safety of "unboosting" atazanavir in a randomized controlled trial among HIV-infected patients receiving tenofovir DF. HIV CLINICAL TRIALS 2017; 18:39-47. [PMID: 28067119 DOI: 10.1080/15284336.2016.1271503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To assess safety and efficacy of a switch to unboosted atazanavir (ATV) among HIV-infected adults receiving ATV/ritonavir (r) and tenofovir disoproxil fumarate (TDF). METHODS HIV-infected adults with viral load (VL) <40 copies/mL at screening and <150 copies/mL consistently for ≥3 months while receiving a regimen including ATV/r and TDF were randomized to continue ATV/r 300/100 mg daily (control) or change to ATV 400 mg daily (switch), while maintaining their TDF backbone. The primary outcome was proportion of subjects without treatment failure (regimen switch or VL > 200 copies/mL twice consecutively) at 48 weeks. RESULTS Fifty participants (46 male, median age 47 years) were randomized, 25 to each arm. At week 48, treatment success occurred in 76% in the control arm and 92% in the switch arm (ITT, p = 0.25). ATV trough levels at week 9 were higher in controls (median 438 ng/mL) than in the switch arm (median 124 ng/mL) (p = 0.003), as was total bilirubin at week 48 (median 38 μmol/L and 28 μmol/L, respectively; p = 0.02). Estimated glomerular filtration rate (eGFR) decreased in the control arm (p = 0.007), but did not change in the switch arm. At week 48, eGFR was higher in the switch arm (median 96 mL/min) than in the control arm (median 85 mL/min) (p = 0.035), but the arms were similar with respect to fasting glucose, C-reactive protein, and lipid parameters. CONCLUSIONS Switching from ATV/r to unboosted ATV appears to be safe and effective in selected virologically suppressed patients receiving TDF-containing regimens, and may have favorable effects on bilirubin and renal function.
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Affiliation(s)
- Marianne Harris
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada.,b Faculty of Medicine, Department of Family Practice , University of British Columbia , Vancouver , Canada.,c Faculty of Medicine, Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Bruce Ganase
- d AIDS Research Program , St. Paul's Hospital , Vancouver , Canada
| | - Birgit Watson
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Mark W Hull
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada.,c Faculty of Medicine, Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Silvia A Guillemi
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada.,b Faculty of Medicine, Department of Family Practice , University of British Columbia , Vancouver , Canada.,c Faculty of Medicine, Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Wendy Zhang
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Ramesh Saeedi
- e Faculty of Medicine, Department of Pathology & Laboratory Medicine , University of British Columbia , Vancouver , Canada
| | - P Richard Harrigan
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada.,c Faculty of Medicine, Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
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12
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Moltó J, Estévez JA, Miranda C, Cedeño S, Clotet B, Valle M. Population pharmacokinetic modelling of the changes in atazanavir plasma clearance caused by ritonavir plasma concentrations in HIV-1 infected patients. Br J Clin Pharmacol 2016; 82:1528-1538. [PMID: 27447851 PMCID: PMC5099552 DOI: 10.1111/bcp.13072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/27/2016] [Accepted: 07/17/2016] [Indexed: 12/18/2022] Open
Abstract
AIMS The aim of the present study was to develop a simultaneous population pharmacokinetic model for atazanavir (ATV) incorporating the effect of ritonavir (RTV) on clearance to predict ATV concentrations under different dosing regimens in HIV-1-infected patients. METHODS A Cross-sectional study was carried out in 83 HIV-1-infected adults taking ATV 400 mg or ATV 300 mg/RTV 100 mg once daily. Demographic and clinical characteristics were registered and blood samples collected to measure drug concentrations. A population pharmacokinetic model was constructed using nonlinear mixed-effects modelling and used to simulate six dosing scenarios. RESULTS The selected one-compartmental model described the pharmacokinetics of RTV and ATV simultaneously, showing exponential, direct inhibition of ATV clearance according to the RTV plasma concentration, which explained 17.5% of the variability. A mean RTV plasma concentration of 0.63 mg l-1 predicted an 18% decrease in ATV clearance. The percentages of patients with an end-of-dose-interval concentration of ATV below or above the minimum and maximum target concentrations of 0.15 mg l-1 and 0.85 mg l-1 favoured the selection of the simulated ATV/RTV once-daily regimens (ATV 400 mg, ATV 300 mg/RTV 100 mg, ATV 300 mg/RTV 50 mg, ATV 200/RTV 100 mg) over the unboosted twice-daily regimens (ATV 300 mg, ATV 200 mg). CONCLUSIONS A one-compartment simultaneous model can describe the pharmacokinetics of RTV and ATV, including the effect of RTV plasma concentrations on ATV clearance. This model is promising for predicting individuals' ATV concentrations in clinical scenarios, and supports further clinical trials of once-daily doses of ATV 300 mg/RTV 50 mg or ATV 200 mg/RTV 100 mg to confirm efficacy and safety.
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Affiliation(s)
- José Moltó
- ‘Lluita contra la Sida’ Foundation, HIV UnitHospital Universitari Germans Trias i PujolBadalonaSpain
- Department de MedicinaUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Javier A. Estévez
- Pharmacokinetic/Pharmacodynamic Modeling and Simulation CIM‐St Pau.Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau‐IIB Sant PauBarcelonaSpain
- Departament de Farmacologia, de Terapèutica i de ToxicologiaUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Cristina Miranda
- ‘Lluita contra la Sida’ Foundation, HIV UnitHospital Universitari Germans Trias i PujolBadalonaSpain
- Department de MedicinaUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Samandhy Cedeño
- ‘IrsiCaixa’ Foundation, HIV UnitHospital Universitari Germans Trias i PujolBadalonaSpain
| | - Bonaventura Clotet
- ‘Lluita contra la Sida’ Foundation, HIV UnitHospital Universitari Germans Trias i PujolBadalonaSpain
- Department de MedicinaUniversitat Autònoma de BarcelonaBarcelonaSpain
- ‘IrsiCaixa’ Foundation, HIV UnitHospital Universitari Germans Trias i PujolBadalonaSpain
| | - Marta Valle
- Pharmacokinetic/Pharmacodynamic Modeling and Simulation CIM‐St Pau.Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau‐IIB Sant PauBarcelonaSpain
- Departament de Farmacologia, de Terapèutica i de ToxicologiaUniversitat Autònoma de BarcelonaBarcelonaSpain
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13
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Effect of Single Nucleotide Polymorphisms in the Xenobiotic-sensing Receptors NR1I2 and NR1I3 on the Pharmacokinetics and Toxicity of Irinotecan in Colorectal Cancer Patients. Clin Pharmacokinet 2016; 55:1145-57. [DOI: 10.1007/s40262-016-0392-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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14
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Giacomelli A, Oreni L, Franzetti M, Di Cristo V, Colella E, Ridolfo AL, Galli M, Rusconi S. Factors involved in continuance of atazanavir-based regimens: Results from a cohort of HIV1-positive patients. Antiviral Res 2016; 129:52-57. [PMID: 26902109 DOI: 10.1016/j.antiviral.2016.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/10/2016] [Accepted: 02/15/2016] [Indexed: 12/31/2022]
Abstract
We evaluated predictive factors involved in durability and therapeutic failure of atazanavir (ATV)-based antiretroviral regimens with or without ritonavir (r) in real life setting. This retrospective study of HIV-1-positive patients evaluated the factors related to ATV continuance and the time-dependent probability of therapeutic failure (HIV-RNA >200 copies/mL and concomitant discontinuation of ATV). We also investigated the rate of therapeutic failure and the variations in total bilirubin levels from starting unboosted ATV-based regimens. The study involved 1030 patients: 183 treatment-naïve patients (17.8%) started ATV/r (17 subsequently switched to unboosted ATV); 653 (63.4%) switched to ATV/r from previous antiretroviral regimens (121 subsequently switched to unboosted ATV); and 194 (18.8%) switched to unboosted ATV from previous ATV-free regimens. The median ATV follow-up was 28 months (interquartile range 7-56). The risk of ATV discontinuation was significantly lower in patients switched to unboosted ATV from ATV/r (HR 0.45; p < 0.0001). The discontinuation of ATV correlated with female gender (HR 1.26; p = 0.035), use of a zidovudine/didanosine/stavudine containing backbone (HR 1.8; p = 0.004), and a baseline CD4+ cell counts of <200/μL (HR 1.54; p = 0.003), the last of which was also associated with a higher risk of therapeutic failure (HR 2.42; p = 0.001). Total bilirubin levels were significantly lower in the patients switching from ATV/r to unboosted ATV. Unboosted ATV-based therapies are safe and effective options in patients whose immuno-virological conditions are stable, and allow the long-term survival of ATV-containing regimens.
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Affiliation(s)
- Andrea Giacomelli
- Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy.
| | - Letizia Oreni
- Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy
| | - Marco Franzetti
- Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy
| | - Valentina Di Cristo
- Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy
| | - Elisa Colella
- Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy
| | - Anna Lisa Ridolfo
- Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy
| | - Massimo Galli
- Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, DIBIC "Luigi Sacco", University of Milan, Milan, Italy
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