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Hindi J, Fréchette-Le Bel M, Rouleau JL, de Denus S. Influence of Weight and Body Size on the Pharmacokinetics of Heart Failure Pharmacotherapy: A Systematic Review. Ann Pharmacother 2024; 58:255-272. [PMID: 37338205 DOI: 10.1177/10600280231179484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE To conduct a review of studies evaluating the influence of body size and weight (WT) on the pharmacokinetics (PK) of drugs recommended for heart failure (HF) treatment. DATA SOURCES A systematic search of the MEDLINE (1946 to April 2023) and EMBASE (1974 to April 2023) databases was conducted for articles that focused on the impact of WT or body size on the PK of drugs of interest used in HF patients. STUDY SELECTION AND DATA EXTRACTION Articles written in English or French related to the aim of our study were retained for analysis. DATA SYNTHESIS Of 6493 articles, 20 were retained for analysis. Weight was associated with the clearance of digoxin, carvedilol, enalapril, and candesartan as well as the volume of distribution of eplerenone and bisoprolol. There was no documented direct impact of WT on the PK of furosemide, valsartan, and metoprolol, although these studies were limited or confounded by the small sample size, adjustment of PK factors by WT, or the use of the Cockroff-Gault equation for the evaluation of creatinine clearance, which includes WT. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review highlights and summarizes the available data on the importance of WT on the PK of HF treatment. CONCLUSION Considering the significant impact of WT on most HF drugs in this review, it may be important to further investigate it in the context of personalized therapy, particularly in patients presenting extreme WTs.
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Affiliation(s)
- Jessica Hindi
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- Montreal Heart Institute, Montreal, QC, Canada
- Beaulieu-Saucier Pharmacogenomics Center, Université de Montréal, Montreal, QC, Canada
| | | | - Jean Lucien Rouleau
- Montreal Heart Institute, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Simon de Denus
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- Montreal Heart Institute, Montreal, QC, Canada
- Beaulieu-Saucier Pharmacogenomics Center, Université de Montréal, Montreal, QC, Canada
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Polasek TM. Pharmacogenomics - a minor rather than major force in clinical medicine. Expert Rev Clin Pharmacol 2024; 17:203-212. [PMID: 38307498 DOI: 10.1080/17512433.2024.2314726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/01/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Pharmacogenomics (PGx) is touted as essential for the future of precision medicine. But the opportunity cost of PGx from the prescribers' perspective is rarely considered. The aim of this article is to critique PGx-guided prescribing using clinical pharmacology principles so that important cases for PGx testing are not missed by doctors responsible for therapeutic decision making. AREAS COVERED Three categories of PGx and their limitations are outlined - exposure PGx, response PGx, and immune-mediated safety PGx. Clinical pharmacology reasons are given for the narrow scope of PGx-guided prescribing apart from a few medical specialties. Clinical problems for doctors that may arise from PGx are then explained, including mismatch between patients' expectations of PGx testing and the benefits or answers it provides. EXPERT OPINION Contrary to popular opinion, PGx is unlikely to become the cornerstone of precision medicine. Sound clinical pharmacology reasons explain why PGx-guided prescribing is unnecessary for most drugs. Pharmacogenomics is important for niche areas of prescribing but has limited clinical utility more broadly. The opportunity cost of PGx-guided prescribing is currently too great for most doctors.
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Affiliation(s)
- Thomas M Polasek
- Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
- CMAX Clinical Research, Adelaide, Australia
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Robert S, Pilon M, Oussaïd E, Meloche M, Leclair G, Jutras M, Gaulin M, Mongrain I, Busseuil D, Tardif J, Dubé M, de Denus S. Impact of amiodarone use on metoprolol concentrations, α-OH-metoprolol concentrations, metoprolol dosing and heart rate: A cross-sectional study. Pharmacol Res Perspect 2023; 11:e01137. [PMID: 37732835 PMCID: PMC10512912 DOI: 10.1002/prp2.1137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/21/2023] [Accepted: 08/03/2023] [Indexed: 09/22/2023] Open
Abstract
Small studies suggest that amiodarone is a weak inhibitor of cytochrome P450 (CYP) 2D6. Inhibition of CYP2D6 leads to increases in concentrations of drugs metabolized by the enzyme, such as metoprolol. Considering that both metoprolol and amiodarone have β-adrenergic blocking properties and that the modest interaction between the two drugs would result in increased metoprolol concentrations, this could lead to a higher risk of bradycardia and atrioventricular block. The primary objective of this study was to evaluate whether metoprolol plasma concentrations collected at random timepoints from patients enrolled in the Montreal Heart Institute Hospital Cohort could be useful in identifying the modest pharmacokinetic interaction between amiodarone and metoprolol. We performed an analysis of a cross-sectional study, conducted as part of the Montreal Heart Institute Hospital Cohort. All participants were self-described "White" adults with metoprolol being a part of their daily pharmacotherapy regimen. Of the 999 patients being treated with metoprolol, 36 were also taking amiodarone. Amiodarone use was associated with higher metoprolol concentrations following adjustment for different covariates (p = .0132). Consistently, the association between amiodarone use and lower heart rate was apparent and significant after adjustment for all covariates under study (p = .0001). Our results highlight that single randomly collected blood samples can be leveraged to detect modest pharmacokinetic interactions.
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Affiliation(s)
- Sabrina Robert
- Faculty of PharmacyUniversité de MontréalMontrealQuebecCanada
| | - Marc‐Olivier Pilon
- Faculty of PharmacyUniversité de MontréalMontrealQuebecCanada
- Montreal Heart InstituteMontrealQuebecCanada
- Université de Montreal Beaulieu‐Saucier Pharmacogenomics CenterMontrealQuebecCanada
| | - Essaïd Oussaïd
- Montreal Heart InstituteMontrealQuebecCanada
- Université de Montreal Beaulieu‐Saucier Pharmacogenomics CenterMontrealQuebecCanada
| | - Maxime Meloche
- Faculty of PharmacyUniversité de MontréalMontrealQuebecCanada
- Montreal Heart InstituteMontrealQuebecCanada
- Université de Montreal Beaulieu‐Saucier Pharmacogenomics CenterMontrealQuebecCanada
| | | | - Martin Jutras
- Faculty of PharmacyUniversité de MontréalMontrealQuebecCanada
| | - Marie‐Josée Gaulin
- Montreal Heart InstituteMontrealQuebecCanada
- Université de Montreal Beaulieu‐Saucier Pharmacogenomics CenterMontrealQuebecCanada
| | - Ian Mongrain
- Montreal Heart InstituteMontrealQuebecCanada
- Université de Montreal Beaulieu‐Saucier Pharmacogenomics CenterMontrealQuebecCanada
| | - David Busseuil
- Montreal Heart InstituteMontrealQuebecCanada
- Université de Montreal Beaulieu‐Saucier Pharmacogenomics CenterMontrealQuebecCanada
| | - Jean‐Claude Tardif
- Montreal Heart InstituteMontrealQuebecCanada
- Université de Montreal Beaulieu‐Saucier Pharmacogenomics CenterMontrealQuebecCanada
- Faculty of MedicineUniversité de MontréalMontrealQuebecCanada
| | - Marie‐Pierre Dubé
- Montreal Heart InstituteMontrealQuebecCanada
- Université de Montreal Beaulieu‐Saucier Pharmacogenomics CenterMontrealQuebecCanada
- Faculty of MedicineUniversité de MontréalMontrealQuebecCanada
| | - Simon de Denus
- Faculty of PharmacyUniversité de MontréalMontrealQuebecCanada
- Montreal Heart InstituteMontrealQuebecCanada
- Université de Montreal Beaulieu‐Saucier Pharmacogenomics CenterMontrealQuebecCanada
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Laverdière J, Meloche M, Provost S, Leclair G, Oussaïd E, Jutras M, Perreault LPL, Valois D, Mongrain I, Busseuil D, Rouleau JL, Tardif JC, Dubé MP, Denus SD. Pharmacogenomic markers of metoprolol and α-OH-metoprolol concentrations: a genome-wide association study. Pharmacogenomics 2023; 24:441-448. [PMID: 37307170 DOI: 10.2217/pgs-2023-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Aim: Few genome-wide association studies (GWASs) have been conducted to identify predictors of drug concentrations. The authors therefore sought to discover the pharmacogenomic markers involved in metoprolol pharmacokinetics. Patients & methods: The authors performed a GWAS of a cross-sectional study of 993 patients from the Montreal Heart Institute Biobank taking metoprolol. Results: A total of 391 and 444 SNPs reached the significance threshold of 5 × 10-8 for metoprolol and α-OH-metoprolol concentrations, respectively. All were located on chromosome 22 at or near the CYP2D6 gene, encoding CYP450 2D6, metoprolol's main metabolizing enzyme. Conclusion: The results reinforce previous findings of the importance of the CYP2D6 locus for metoprolol concentrations and confirm that large biobanks can be used to identify genetic determinants of drug pharmacokinetics at a GWAS significance level.
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Affiliation(s)
- Jean Laverdière
- Faculty of Pharmacy, Université de Montréal, H3T 1J4, Montreal, Quebec, Canada
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Université de Montreal Beaulieu-Saucier Pharmacogenomics Centre, H1T 1C8, Montreal, Quebec, Canada
| | - Maxime Meloche
- Faculty of Pharmacy, Université de Montréal, H3T 1J4, Montreal, Quebec, Canada
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Université de Montreal Beaulieu-Saucier Pharmacogenomics Centre, H1T 1C8, Montreal, Quebec, Canada
| | - Sylvie Provost
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Université de Montreal Beaulieu-Saucier Pharmacogenomics Centre, H1T 1C8, Montreal, Quebec, Canada
| | - Grégoire Leclair
- Faculty of Pharmacy, Université de Montréal, H3T 1J4, Montreal, Quebec, Canada
| | - Essaïd Oussaïd
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Université de Montreal Beaulieu-Saucier Pharmacogenomics Centre, H1T 1C8, Montreal, Quebec, Canada
| | - Martin Jutras
- Faculty of Pharmacy, Université de Montréal, H3T 1J4, Montreal, Quebec, Canada
| | - Louis-Philippe Lemieux Perreault
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Université de Montreal Beaulieu-Saucier Pharmacogenomics Centre, H1T 1C8, Montreal, Quebec, Canada
| | - Diane Valois
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Université de Montreal Beaulieu-Saucier Pharmacogenomics Centre, H1T 1C8, Montreal, Quebec, Canada
| | - Ian Mongrain
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Université de Montreal Beaulieu-Saucier Pharmacogenomics Centre, H1T 1C8, Montreal, Quebec, Canada
| | - David Busseuil
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Université de Montreal Beaulieu-Saucier Pharmacogenomics Centre, H1T 1C8, Montreal, Quebec, Canada
| | - Jean Lucien Rouleau
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Faculty of Medicine, Université de Montréal, H3T 1J4, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Université de Montreal Beaulieu-Saucier Pharmacogenomics Centre, H1T 1C8, Montreal, Quebec, Canada
- Faculty of Medicine, Université de Montréal, H3T 1J4, Montreal, Quebec, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Université de Montreal Beaulieu-Saucier Pharmacogenomics Centre, H1T 1C8, Montreal, Quebec, Canada
- Faculty of Medicine, Université de Montréal, H3T 1J4, Montreal, Quebec, Canada
| | - Simon de Denus
- Faculty of Pharmacy, Université de Montréal, H3T 1J4, Montreal, Quebec, Canada
- Montreal Heart Institute, H1T 1C8, Montreal, Quebec, Canada
- Université de Montreal Beaulieu-Saucier Pharmacogenomics Centre, H1T 1C8, Montreal, Quebec, Canada
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Hindi J, Pilon MO, Meloche M, Leclair G, Oussaïd E, St-Jean I, Jutras M, Gaulin MJ, Mongrain I, Busseuil D, Rouleau JL, Tardif JC, Dubé MP, de Denus S. Females present higher dose-adjusted drug concentrations of metoprolol and allopurinol/oxypurinol than males. Clin Transl Sci 2023; 16:872-885. [PMID: 36864560 PMCID: PMC10175982 DOI: 10.1111/cts.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 03/04/2023] Open
Abstract
Females present a higher risk of adverse drug reactions. Sex-related differences in drug concentrations may contribute to these observations but they remain understudied given the underrepresentation of females in clinical trials. The aim of this study was to investigate whether anthropometric and socioeconomic factors and comorbidities could explain sex-related differences in concentrations and dosing for metoprolol and oxypurinol, the active metabolite of allopurinol. We conducted an analysis of two cross-sectional studies. Participants were self-described "White" adults taking metoprolol or allopurinol selected from the Montreal Heart Institute Hospital Cohort. A total of 1007 participants were included in the metoprolol subpopulation and 459 participants in the allopurinol subpopulation; 73% and 86% of the participants from the metoprolol and allopurinol subpopulations were males, respectively. Females presented higher age- and dose-adjusted concentrations of both metoprolol and oxypurinol (both p < 0.03). Accordingly, females presented higher unadjusted and age-adjusted concentration:dose ratio of both metoprolol and allopurinol/oxypurinol compared to males (all p < 3.0 × 10-4 ). Sex remained an independent predictor of metoprolol concentrations (p < 0.01), but not of oxypurinol concentrations, after adjusting for other predictors. In addition to sex, age, daily dose, use of moderate to strong CYP2D6 inhibitors, weight, and CYP2D6 genotype-inferred phenotype were associated with concentrations of metoprolol (all p < 0.01). Daily dose, weight, estimated glomerular filtration rate (eGFR), and employment status were associated with oxypurinol concentrations (all p < 0.01). Females present higher dose-adjusted concentrations of metoprolol and oxypurinol than males. This suggests the need for sex-specific dosing requirements for these drugs, although this hypothesis should be validated in prospective studies.
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Affiliation(s)
- Jessica Hindi
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Quebec, Canada
| | - Marc-Olivier Pilon
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Quebec, Canada
| | - Maxime Meloche
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Quebec, Canada
| | - Grégoire Leclair
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Essaïd Oussaïd
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Quebec, Canada
| | - Isabelle St-Jean
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Jutras
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Josée Gaulin
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Quebec, Canada
| | - Ian Mongrain
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Quebec, Canada
| | - David Busseuil
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Quebec, Canada
| | - Jean Lucien Rouleau
- Montreal Heart Institute, Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Simon de Denus
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montréal Beaulieu-Saucier Pharmacogenomics Centre, Montreal, Quebec, Canada
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6
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Pilon MO, Leclair G, Oussaïd E, St-Jean I, Jutras M, Gaulin MJ, Mongrain I, Busseuil D, Rouleau JL, Tardif JC, Dubé MP, de Denus S. An association study of ABCG2 rs2231142 on the concentrations of allopurinol and its metabolites. Clin Transl Sci 2022; 15:2024-2034. [PMID: 35689378 PMCID: PMC9372422 DOI: 10.1111/cts.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
ABCG2 is a gene that codes for the human breast cancer resistance protein (BCRP). It is established that rs2231142 G>T, a single nucleotide polymorphism of the ABCG2 gene, is associated with gout and poor response to allopurinol, a uric acid‐lowering agent used to treat this condition. It has also been suggested that oxypurinol, the primary active metabolite of allopurinol, is a substrate of the BCRP. We thus hypothesized that carrying the rs2231142 variant would be associated with decreased oxypurinol concentrations, which would explain the lower reduction in uric acid. We performed a cross‐sectional study to investigate the association between the ABCG2 rs2231142 variant and oxypurinol, allopurinol, and allopurinol riboside concentrations in 459 participants from the Montreal Heart Institute Hospital Cohort. Age, sex, weight, use of diuretics, and estimated glomerular filtration rate were all significantly associated with oxypurinol plasma concentration. No association was found between rs2231142 and oxypurinol, allopurinol and allopurinol riboside plasma concentrations. Rs2231142 was not significantly associated with daily allopurinol dose in the overall population, but an association was observed in men, with T carriers receiving higher doses. Our results do not support a major role of ABCG2 in the pharmacokinetics of allopurinol or its metabolites. The underlying mechanism of the association between rs2231142 and allopurinol efficacy requires further investigation.
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Affiliation(s)
- Marc-Olivier Pilon
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Quebec, Canada
| | - Grégoire Leclair
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Essaïd Oussaïd
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Quebec, Canada
| | - Isabelle St-Jean
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Jutras
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Josée Gaulin
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Quebec, Canada
| | - Ian Mongrain
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Quebec, Canada
| | - David Busseuil
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Quebec, Canada
| | - Jean Lucien Rouleau
- Montreal Heart Institute, Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Quebec, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Simon de Denus
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Montreal, Quebec, Canada.,Université de Montreal Beaulieu-Saucier Pharmacogenomics Center, Montreal, Quebec, Canada
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