1
|
Gloor Y, Lloret-Linares C, Bosilkovska M, Perroud N, Richard-Lepouriel H, Aubry JM, Daali Y, Desmeules JA, Besson M. Drug metabolic enzyme genotype-phenotype discrepancy: High phenoconversion rate in patients treated with antidepressants. Biomed Pharmacother 2022; 152:113202. [PMID: 35653884 DOI: 10.1016/j.biopha.2022.113202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/02/2022] Open
Abstract
Cytochromes from the P450 family (CYP) play a central role in the primary metabolism of frequently prescribed antidepressants, potentially affecting their efficacy and tolerance. There are however important differences in the drug metabolic capacities of each individual resulting from a combination of intrinsic and environmental factors. This variability can present an important risk for patients and increases the difficulty of drug prescription in clinical practice. Pharmacogenetic studies have uncovered a number of alleles defining the intrinsic metabolizer status, however, additional factors affecting cytochrome activity can modify this activity and result in a phenoconversion. The present study investigates the discrepancy between the genetically predicted and actually measured activities for the six most important liver cytochromes (CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6 and CYP3A4) in a cohort of patients under antidepressant treatment, previously shown to have a high proportion of patients with low metabolizing activities. We now performed the genetic characterization of this cohort to determine the extent of the genetic versus environmental contribution in these decreased activities. For all enzyme tested, we observed an important rate of phenoconversion, affecting between 33 % and 65 % of the patients, as well as a significant (p < 1E-06) global reduction in the effective but not predicted activities of CYP2D6, CYP2C9 and CYP2C19 compared to the general population. Our results highlight the advantages of phenotyping versus genotyping as well as the increased risk of treatment failure or adverse effect occurrence in a polymedicated population.
Collapse
Affiliation(s)
- Y Gloor
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency, Geneva University Hospitals (HUG), Geneva, Switzerland.
| | - C Lloret-Linares
- Department of Nutritional and Metabolic Diseases, Ramsay Générale de Santé, Pays de Savoie Private Hospital, Annemasse, France
| | - M Bosilkovska
- Clinical Pharmacology and Toxicology, Department of Anaesthetics Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland
| | - N Perroud
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland; Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - H Richard-Lepouriel
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland; Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - J-M Aubry
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland
| | - Y Daali
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency, Geneva University Hospitals (HUG), Geneva, Switzerland; Clinical Pharmacology and Toxicology, Department of Anaesthetics Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, Geneva, Switzerland
| | - J A Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency, Geneva University Hospitals (HUG), Geneva, Switzerland; Clinical Pharmacology and Toxicology, Department of Anaesthetics Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, Geneva, Switzerland
| | - M Besson
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency, Geneva University Hospitals (HUG), Geneva, Switzerland; Clinical Pharmacology and Toxicology, Department of Anaesthetics Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland
| |
Collapse
|
2
|
Thomazeau J, Rouquette A, Martinez V, Rabuel C, Prince N, Laplanche JL, Nizard R, Bergmann JF, Perrot S, Lloret-Linares C. Acute pain Factors predictive of post-operative pain and opioid requirement in multimodal analgesia following knee replacement. Eur J Pain 2015; 20:822-32. [PMID: 26517014 DOI: 10.1002/ejp.808] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite the development of multimodal analgesia for postoperative pain management, opioids are still required for effective pain relief after knee arthroplasty. We aimed to identify the determinants of post-operative pain intensity and post-operative opioid requirement in this context. METHODS In this observational prospective study, we recorded patient characteristics, pre-operative pain intensity, anxiety and depression levels, sensitivity and pain thresholds in response to an electrical stimulus, and mu-opioid receptor (OPRM1) and catechol-O-methyltransferase (COMT) single-nucleotide polymorphisms. Multivariate linear regression models were used to identify predictors of post-operative pain at rest and opioid requirement. RESULTS We included 109 patients. Pre-operative pain at rest (p = 0.047), anxiety level (p = 0.001) and neuropathic pain symptoms (p = 0.030) were independently and positively associated with mean post-operative pain intensity adjusted for mean post-operative morphine equivalent dose (MED). Mean post-operative pain intensity at rest was lower (p = 0.006) in patients receiving celecoxib and pregabalin in the post-operative period, with all other variables constant. Mean post-operative MED over 5 days was low, but highly variable (78.2 ± 32.1 mg, from 9.9 to 170 mg). Following adjustment for mean post-operative pain intensity, it was independently negatively correlated with age (p = 0.004), and positively correlated with associated paracetamol treatment (p = 0.031). No genetic effect was detected in our sample. CONCLUSIONS Our findings suggest that clinicians could use the pre-operative pain profile, in terms of anxiety levels, neuropathic pain symptoms, and chronic pre-operative pain intensity, to improve the efficacy of pain management after knee surgery.
Collapse
Affiliation(s)
- J Thomazeau
- INSERM 987, Physiopathologie et pharmacologie clinique de la douleur, Ambroise Paré, Paris, France.,Assistance Publique-Hôpitaux de Paris, Therapeutic Research Unit, Department of Internal Medicine, Hôpital Lariboisière, Paris, France
| | - A Rouquette
- Assistance Publique-Hôpitaux de Paris, Biostatistics and Epidemiology Department, Hôpital Hôtel Dieu, Paris, France.,INSERM U1178, Mental Health and Public Health, Paris-Sud and Paris Descartes Universities, Paris, France
| | - V Martinez
- INSERM 987, Physiopathologie et pharmacologie clinique de la douleur, Ambroise Paré, Paris, France
| | - C Rabuel
- Assistance Publique-Hôpitaux de Paris, Service de chirurgie orthopédique et traumatologique, Hôpital Lariboisière, Paris, France
| | - N Prince
- INSERM U1144, Variabilité de réponse aux psychotropes, Universités Paris Descartes and Paris Diderot, France
| | - J L Laplanche
- INSERM U1144, Variabilité de réponse aux psychotropes, Universités Paris Descartes and Paris Diderot, France
| | - R Nizard
- Assistance Publique-Hôpitaux de Paris, Service de chirurgie orthopédique et traumatologique, Hôpital Lariboisière, Paris, France
| | - J F Bergmann
- Assistance Publique-Hôpitaux de Paris, Therapeutic Research Unit, Department of Internal Medicine, Hôpital Lariboisière, Paris, France.,INSERM U1144, Variabilité de réponse aux psychotropes, Universités Paris Descartes and Paris Diderot, France
| | - S Perrot
- INSERM 987, Physiopathologie et pharmacologie clinique de la douleur, Ambroise Paré, Paris, France.,Centre d'Evaluation et de Traitement de la Douleur, Hôpital Hôtel Dieu, Paris, France
| | - C Lloret-Linares
- Assistance Publique-Hôpitaux de Paris, Therapeutic Research Unit, Department of Internal Medicine, Hôpital Lariboisière, Paris, France.,INSERM U1144, Variabilité de réponse aux psychotropes, Universités Paris Descartes and Paris Diderot, France
| |
Collapse
|
3
|
Mouly S, Morgand M, Lopes A, Lloret-Linares C, Bergmann JF. Interactions médicaments–aliments en médecine interne : quels messages pour le clinicien ? Rev Med Interne 2015; 36:530-9. [DOI: 10.1016/j.revmed.2014.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 12/22/2014] [Indexed: 01/31/2023]
|
4
|
Lloret-Linares C, Hachon L. Adaptation posologique chez le sujet obèse. Réanimation 2015. [DOI: 10.1007/s13546-015-1086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
5
|
Comarmond C, Crestani B, Tazi A, Hervier B, Adam Marchand S, Nunes H, Cohen-Aubart F, Wislez M, Cadranel J, Housset B, Lloret-Linares C, Sève P, Pagnoux C, Abad S, Camuset J, Bienvenu B, Duruisseaux M, Hachulla E, Arlet JB, Hamidou M, Mahr A, Resche-Rigon M, Brun AL, Grenier P, Cacoub P, Saadoun D. FRI0460 Pulmonary Fibrosis in Anca-Associated Vasculitis: Clinical Characteristics and Long-Term Followup of 49 Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
6
|
Faye E, Corcos O, Lancelin F, Declèves X, Bergmann JF, Joly F, Lloret-Linares C. P236 Absorption du citalopram et de l’escitalopram chez les sujets souffrant d’un syndrome de grêle court. NUTR CLIN METAB 2013. [DOI: 10.1016/s0985-0562(13)70567-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
7
|
Faye E, Drouet L, De Raucourt E, Boudaoud L, Bal-dit-Sollier C, Bergmann JF, Corcos O, Joly F, Lloret-Linares C. P235 Absorption et efficacité de l’aspirine par voie orale chez les sujets souffrant d’un grêle court. NUTR CLIN METAB 2013. [DOI: 10.1016/s0985-0562(13)70566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
8
|
Jarrin I, Poiroux F, Muhlen D, Debellis N, Alric P, Augizeau E, Sauban L, Andrianmanantenasoa M, Drymon S, Berreby L, Farout M, Climberte L, Bergmann JF, Lloret-Linares C. P165 Effet du choix des repas sur la prise alimentaire et la satisfaction des patients hospitalisés en service de médecine interne. NUTR CLIN METAB 2013. [DOI: 10.1016/s0985-0562(13)70497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
9
|
Abstract
Weight loss is associated with improvements in glycaemic control and cardiovascular disease risk factors. However, in the diabetic population, weight management is more challenging, in part because of the weight-promoting effects of the majority of glucose-lowering therapies. This review summarizes evidence from 23 placebo-controlled randomized trials, of at least 1 year duration, on the effects of drugs promoting weight loss (orlistat, sibutramine and rimonabant) on glycaemic variables, diabetes incidence and diabetes control. Fifteen studies of non-diabetic subjects were found, eight of which included a longer treatment period. Eight studies in diabetic patients were reviewed. In non-diabetic subjects, weight loss agents led to a significant improvement in fasting glucose, fasting insulin and insulin resistance. In the diabetic population, glycated haemoglobin decreased by 0.28-1.1% with orlistat and 0.6% with sibutramine and rimonabant. Orlistat reduces progression to diabetes in patients with glucose intolerance treated for 4 years (risk reduction of 45%). In summary, despite leading to only modest weight loss after 12 months, agents promoting weight loss have beneficial effects on glycaemic parameters, glycaemic control and progression to diabetes. These additional benefits of weight loss agents need to be highlighted in order to increase their judicious use in clinical practice, although this may be limited by their well-known adverse side effects. The longer-term safety of these agents beyond a few years is yet to be established.
Collapse
Affiliation(s)
- C Lloret-Linares
- Nutrition Department, Pitíe-Salpetriàre Hospital (AP-HP), Paris, France
| | | | | |
Collapse
|