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Xiang Q, Xie Q, Liu Z, Mu G, Zhang H, Zhou S, Wang Z, Wang Z, Zhang Y, Zhao Z, Yuan D, Guo L, Wang N, Xiang J, Song H, Sun J, Jiang J, Cui Y. Genetic variations in relation to bleeding and pharmacodynamics of dabigatran in Chinese patients with nonvalvular atrial fibrillation: A nationwide multicentre prospective cohort study. Clin Transl Med 2022; 12:e1104. [PMID: 36453946 PMCID: PMC9714378 DOI: 10.1002/ctm2.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION To identify the potential factors responsible for the individual variability of dabigatran, we investigated the genetic variations associated with clinical outcomes and pharmacodynamics (PD) in Chinese patients with nonvalvular atrial fibrillation (NVAF). MATERIALS AND METHODS Chinese patients with NVAF taking dabigatran etexilate with therapeutic doses were enrolled. The primary (bleeding events) and secondary (thromboembolic and major adverse cardiac events) outcomes for a 2-year follow-up were evaluated. Peak and trough PD parameters (anti-FIIa activity, activated partial thromboplastin time and prothrombin time) were detected. Whole-exome sequencing, genome-wide sequencing and candidate gene association analyses were performed. RESULTS There were 170 patients with NVAF treated with dabigatran (110 mg twice daily) who were finally included. Two single-nucleotide polymorphisms (SNPs) were significantly related with bleeding, which include UBASH3B rs2276408 (odds ratio [OR] = 8.79, 95% confidence interval [CI]: 2.99-25.83, p = 7.77 × 10-5 at sixth month visit) and FBN2 rs3805625 (OR = 8.29, 95% CI: 2.87-23.89, p = 9.08 × 10-5 at 12th month visit), as well as with increased trends at other visits (p < .05). Furthermore, minor allele carriers of 16 new SNPs increased PD levels, and those of one new SNP decreased PD values (p < 1.0 × 10-5 ). Lastly, 33 new SNPs were found to be associated with bleeding and PD among 14 candidate genes. Unfortunately, the low number of secondary outcomes precluded further association analyses. CONCLUSIONS Genetic variations indeed affected bleeding and PD in Chinese patients with NVAF treated with dabigatran. The functions of these suggestive genes and SNPs might further be explored and verified in more in vivo and in vitro investigations.
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Affiliation(s)
- Qian Xiang
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Qiufen Xie
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Zhiyan Liu
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Guangyan Mu
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Hanxu Zhang
- Department of PharmacyPeking University First HospitalBeijingChina
- School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Shuang Zhou
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Zhe Wang
- Department of PharmacyPeking University First HospitalBeijingChina
- School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Zining Wang
- Department of PharmacyPeking University First HospitalBeijingChina
| | - Yatong Zhang
- Department of PharmacyBeijing HospitalBeijingChina
| | - Zinan Zhao
- Department of PharmacyBeijing HospitalBeijingChina
| | - Dongdong Yuan
- Department of PharmacyZhengzhou Seventh People's HospitalZhengzhouChina
| | - Liping Guo
- Department of PharmacyZhengzhou Seventh People's HospitalZhengzhouChina
| | - Na Wang
- Department of PharmacyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jing Xiang
- Department of PharmacyThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Hongtao Song
- Department of Pharmacy900 Hospital of the Joint Logistics TeamFuzhouChina
| | - Jianjun Sun
- Department of PharmacyThe Affiliated Hospital of Inner Mongolia Medical UniversityHuhehaoteChina
| | - Jie Jiang
- Department of CardiologyPeking University First HospitalBeijingChina
| | - Yimin Cui
- Department of PharmacyPeking University First HospitalBeijingChina
- School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
- Institute of Clinical PharmacologyPeking UniversityBeijingChina
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Liu YO, Xie QF, Liu ZY, Wang Z, Mu GY, Zhang YT, Zhao ZN, Yuan DD, Guo LP, Wang N, Xiang J, Song HT, Jiang J, Xiang Q, Cui YM. Population pharmacokinetic analysis for dabigatran etexilate in Chinese patients with non-valvular atrial fibrillation. Front Cardiovasc Med 2022; 9:998751. [PMID: 36386303 PMCID: PMC9650305 DOI: 10.3389/fcvm.2022.998751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/06/2022] [Indexed: 11/14/2023] Open
Abstract
We aimed to develop a pharmacokinetic (PK) and pharmacodynamic (PD) model from healthy Chinese subjects and real-world non-valvular atrial fibrillation (NVAF) patients. We also investigated meaningful intrinsic and extrinsic factors and related biomarkers for bleeding events. We characterized the integrated PK/PD models based on rich PK/PD data [dabigatran concentration, activated partial thromboplastin time (APTT), prothrombin time (PT), and anti-factor IIa (anti-FIIa) activity] from 118 healthy volunteers and sparse PD data [APTT, PT, and anti-FIIa] from 167 patients with NVAF after verifying the model extrapolation performance. We also documented the correlations between PD biomarkers and clinically relevant bleeding events over one year. Next, we used the final integrated PK/PD model (a two-compartment, linear model with first-order absorption) to evaluate the influence of dosage and individual covariates on PD parameters. The age, high-density liptein cholesterol (HDL-C), and creatinine clearance (CrCL) improved the PK model fit. The linear direct-effects PD model described the correlation between APTT, PT, and anti-FIIa and plasma concentration. CrCL improved the PD model fit. Anti-FIIa was more sensitive to the increase in dabigatran exposure than APTT and PT in the PD model. Therefore, fixed dabigatran doses could be prescribed for patients with NVAF without adjusting for age and HDL-C. We observed an elevated bleeding tendency with higher peak and trough values of APTT, PT, and anti-FIIa. Randomized studies should be performed to evaluate the efficacy and safety of low-dose dabigatran in Chinese patients with NVAF.
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Affiliation(s)
- Ya-ou Liu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Qiu-fen Xie
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Zhi-yan Liu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Zhe Wang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Guang-yan Mu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Ya-tong Zhang
- Department of Pharmacy, Beijing Hospital, Beijing, China
| | - Zi-nan Zhao
- Department of Pharmacy, Beijing Hospital, Beijing, China
| | - Dong-dong Yuan
- Department of Pharmacy, Zhengzhou Seventh People's Hospital, Zhengzhou, China
| | - Li-ping Guo
- Department of Pharmacy, Zhengzhou Seventh People's Hospital, Zhengzhou, China
| | - Na Wang
- Department of Pharmacy, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Xiang
- Department of Pharmacy, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong-tao Song
- Department of Pharmacy, 900 Hospital of the Joint Logistics Team, Fuzhou, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Yi-min Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
- Institute of Clinical Pharmacology, Peking University, Beijing, China
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Xie Q, Li Y, Liu Z, Mu G, Zhang H, Zhou S, Wang Z, Wang Z, Jiang J, Li X, Xiang Q, Cui Y. SLC4A4, FRAS1, and SULT1A1 Genetic Variations Associated With Dabigatran Metabolism in a Healthy Chinese Population. Front Genet 2022; 13:873031. [PMID: 35646073 PMCID: PMC9136018 DOI: 10.3389/fgene.2022.873031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/07/2022] [Indexed: 12/21/2022] Open
Abstract
Background: The purpose of this study was to identify genetic variations associated with the metabolism of dabigatran in healthy Chinese subjects, with particular focus given to pharmacokinetics (PK) and pharmacodynamics (PD).Methods: Healthy Chinese adults aged 18–65 years with unknown genotypes from a bioequivalence trial were included according to the protocol registered at ClinicalTrial.org (NCT03161496). All subjects received a single dose (150 mg) of dabigatran etexilate. PK (main outcomes: area under the concentration-time, AUC0-t, of total and free dabigatran) and PD (main outcomes: anti-FIIa activity, APTT, and PT) parameters were evaluated. Whole-exome sequencing and genome-wide association analyses were performed. Additionally, candidate gene association analyses related to dabigatran were conducted.Results: A total of 118 healthy Chinese subjects were enrolled in this study. According to the p-value suggestive threshold (1.0 × 10−4), the following three SNPs were found to be associated with the AUC0–t of total dabigatran: SLC4A4 SNP rs138389345 (p = 5.99 × 10−5), FRAS1 SNP rs6835769 (p = 6.88 × 10−5), and SULT1A1 SNP rs9282862 (p = 7.44 × 10−5). Furthermore, these SNPs were also found to have significant influences on the AUC0–t of free dabigatran, maximum plasma concentration, and anti-FIIa activity (p < 0.05). Moreover, we identified 30 new potential SNPs of 13 reported candidate genes (ABCB1, ABCC2, ABCG2, CYP2B6, CYP1A2, CYP2C19, CYP3A5, CES1, SLCO1B1, SLC22A1, UGT1A1, UGT1A9, and UGT2B7) that were associated with drug metabolism.Conclusion: Genetic variations were indeed found to impact dabigatran metabolism in a population of healthy Chinese subjects. Further research is needed to explore the more detailed functions of these SNPs. Additionally, our results should be verified in studies that use larger sample sizes and investigate other ethnicities.
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Affiliation(s)
- Qiufen Xie
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Yuan Li
- Department of Pharmacy, The Third Hospital of Changsha, Changsha, China
| | - Zhiyan Liu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Guangyan Mu
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Hanxu Zhang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Shuang Zhou
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Zhe Wang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Zining Wang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Xin Li
- Department of Pharmacy, The Third Hospital of Changsha, Changsha, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China
- School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
- Institute of Clinical Pharmacology, Peking University, Beijing, China
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