在接受沃里康纳的患者中,炎症改变了CYP2C19基因型和CYP2C19活性之间的相关性
Sylvia D Klomp1, Anette Veringa2,3, Jan-Willem C Alffenaar2,4,5,6
1Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, The Netherlands.
炎症通过抑制CYP2C19活性来增加伏利康纳水平,导致不论基因型的变异. 这对患有真菌感染的患者的伏利可纳暴露产生影响.
科学领域:
- 药理学 药理学是指药理学的学科.
- 临床药房 临床药房
- 医学真菌学 医学真菌学
背景情况:
- 沃里康纳对于治疗和预防真菌感染至关重要.
- CYP2C19基因型与预防中的伏利康纳暴露相关,但与侵入性阿斯伯吉洛症无关.
- 预炎性细胞因子可以抑制CYP2C19的活性,可能导致转化.
研究的目的:
- 为了研究炎症之间的关系,CYP2C19基因型预测的表型,和实际的CYP2C19活性在接受voriconazole的患者.
主要方法:
- 利用了两项前性伏利可纳治疗研究 (NCT02074462,NCT00893555) 的数据.
- 评估CYP2C19活性和炎症,分别使用剂量校正的伏利康纳血度和C-反应蛋白 (CRP) 水平.
- 分析了来自39名患者的数据,其中包括对联沃里康纳和CRP测量.
主要成果:
- CYP2C19的基因型分布: 31%的中间 (IM),41%的正常 (NM) 和28%的快速代谢者 (RM).
- 在炎症期间,经剂量校正后,沃里可纳水平在所有表型中显著增加 (NMS的245%,IM的278%,RM的486%).
- 患有高CRP (>50 mg/L) 的患者,无论其基线CYP2C19基因型如何,都表现出向较低代谢器表型的表转化.
结论:
- 炎症降低了CYP2C19的活性,导致伏利康纳的血度增加.
- 在炎症期间发生转换到较低的代谢器状态,影响伏利可纳暴露.
- 虽然这种影响在快速代谢者中最为明显,但在这种情况下,在CYP2C19基因型之间没有观察到临床上显著的差异.
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