Assessing the clinical impact of CYP2C9 pharmacogenetic variation on phenytoin prescribing practice and patient response in an integrated health system.

Abstract:

OBJECTIVE:To assess the impact of CYP2C9 variation on phenytoin patient response and clinician prescribing practice where genotype was unknown during treatment. METHODS:A retrospective analysis of Resource on Genetic Epidemiology Research on Adult Health and Aging cohort participants who filled a phenytoin prescription between 1996 and 2017. We used laboratory test results, medication dispensing records, and medical notes to identify associations of CYP2C9 genotype with phenytoin blood concentration, neurologic side effects, and medication dispensing patterns reflecting clinician prescribing practice and patient response. RESULTS:Among 993 participants, we identified 69% extensive, 20% high-intermediate, 10% low-intermediate, and 2% poor metabolizers based on CYP2C9 genotypes. Compared with extensive metabolizer genotype, low-intermediate/poor metabolizer genotype was associated with increased dose-adjusted phenytoin blood concentration [21.3 pg/mL, 95% confidence interval (CI): 13.6-29.0 pg/mL; P < 0.01] and increased risk of neurologic side effects (hazard ratio: 2.40, 95% CI: 1.24-4.64; P < 0.01). Decreased function CYP2C9 genotypes were associated with medication dispensing patterns indicating dose decrease, use of alternative anticonvulsants, and worse adherence, although these associations varied by treatment indication for phenytoin. CONCLUSION:CYP2C9 variation was associated with clinically meaningful differences in clinician prescribing practice and patient response, with potential implications for healthcare utilization and treatment efficacy.

journal_name

Pharmacogenet Genomics

authors

Fohner AE,Ranatunga DK,Thai KK,Lawson BL,Risch N,Oni-Orisan A,Jelalian AT,Rettie AE,Liu VX,Schaefer CA

doi

10.1097/FPC.0000000000000383

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

192-199

issue

8

eissn

1744-6872

issn

1744-6880

pii

01213011-201910000-00002

journal_volume

29

pub_type

杂志文章
  • Novel CYP2A6 variants identified in African Americans are associated with slow nicotine metabolism in vitro and in vivo.

    abstract:OBJECTIVE:Nicotine, the main addictive ingredient in tobacco, is metabolically inactivated to cotinine primarily by the hepatic enzyme CYP2A6. Considerable genetic variation in the CYP2A6 gene results in large variation in the rates of nicotine metabolism, which in turn alters smoking behaviours (e.g. amount of cigaret...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0000000000000026

    authors: Piliguian M,Zhu AZ,Zhou Q,Benowitz NL,Ahluwalia JS,Sanderson Cox L,Tyndale RF

    更新日期:2014-02-01 00:00:00

  • Remarkably low incidence of hypospadias in Greenland despite high exposure to endocrine disrupters; possible protective effect of androgen receptor genotype.

    abstract::Endocrine disrupters, such as persistent organohalogen pollutants (POPs) may cause hypospadias, which is a common congenital anomaly in males, affecting 0.2-0.7%. We hypothesized that hypospadias incidence would be high among Greenlanders, who are one of the most POP exposed populations on earth through consumption of...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/01.fpc.0000199497.01101.93

    authors: Giwercman YL,Kleist KE,Giwercman A,Giwercman C,Toft G,Bonde JP,Pedersen HS

    更新日期:2006-05-01 00:00:00

  • Multidrug resistance-related protein 2 genotype of the donor affects kidney graft function.

    abstract:OBJECTIVES:We tested the effect of kidney-specific multidrug resistance-related protein (MRP2, ABCC2) deficiency on renal organic solute disposition as well as on renal protein and gene expression. Furthermore, we investigated whether a particular kidney donor ABCC2 genotype is associated with delayed graft function in...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e328328d4e9

    authors: Grisk O,Steinbach AC,Ciecholewski S,Schlüter T,Klöting I,Schmidt H,Dazert E,Schaeffeler E,Steil L,Gauer S,Jedlitschky G,Schwab M,Geisslinger G,Hauser IA,Völker U,Kroemer HK,Rettig R

    更新日期:2009-04-01 00:00:00

  • Catecholamine pathway gene variation is associated with norepinephrine and epinephrine concentrations at rest and after exercise.

    abstract:OBJECTIVE:To examine the hypothesis that genetic variation in enzymes and transporters associated with synthesis, storage, release, and metabolism of catecholamines contributes to the interindividual variability in plasma catecholamine concentrations at rest and after exercise. METHODS:We measured plasma norepinephrin...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e328350a274

    authors: Ghimire LV,Kohli U,Li C,Sofowora GG,Muszkat M,Friedman EA,Solus JF,Wood AJ,Stein CM,Kurnik D

    更新日期:2012-04-01 00:00:00

  • Association of Cullin1 haplotype variants with rheumatoid arthritis and response to methotrexate.

    abstract::Aberrations in ubiquitin pathway have been implicated in many diseases and drug response. In a previous study on rheumatoid arthritis (RA) in Japanese population, significant association of Cullin1 gene (CUL1), an ubiquitin E3 ligase, was observed. CUL1 also mediates degradation of IκBα and p27, levels of which has be...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e3283492af7

    authors: Negi S,Kumar A,Thelma BK,Juyal RC

    更新日期:2011-09-01 00:00:00

  • A candidate-gene association study of topiramate-induced weight loss in obese patients with and without type 2 diabetes mellitus.

    abstract:OBJECTIVE:Clinical response to topiramate can vary greatly in obese patients. Identifying genetic variants associated with treatment response could help gain insight into the mechanism of action of topiramate. Little is known about the relationship between genetic variability and topiramate treatment response. We perfo...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0000000000000185

    authors: Li QS,Lenhard JM,Zhan Y,Konvicka K,Athanasiou MC,Strauss RS,Francke S

    更新日期:2016-02-01 00:00:00

  • Integrating interacting drugs and genetic variations to improve the predictability of warfarin maintenance dose in Chinese patients.

    abstract:OBJECTIVE:Compared with genetic factors, drug interactions are largely unexplored in pharmacogenetic studies. This study sought to systematically investigate the effects of VKORC1, STX4A, CYP2C9, CYP4F2, CYP3A4, and GGCX gene polymorphisms and interacting drugs on warfarin maintenance dose. METHODS:A retrospective stu...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e32834f45f9

    authors: Zhong SL,Yu XY,Liu Y,Xu D,Mai LP,Tan HH,Lin QX,Yang M,Lin SG

    更新日期:2012-03-01 00:00:00

  • Endothelial nitric oxide synthase gene haplotypes associated with circulating concentrations of nitric oxide products in healthy men.

    abstract:OBJECTIVES:Controversy exists regarding the effects of polymorphisms in the endothelial nitric oxide synthase (eNOS) gene on nitrites/nitrates (NOx) plasma concentrations. In this study we compared the distribution of haplotypes involving three relevant eNOS polymorphisms (T-786C in the promoter region; b/a in intron 4...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/01.fpc.0000167328.85163.44

    authors: Metzger IF,Souza-Costa DC,Marroni AS,Nagassaki S,Desta Z,Flockhart DA,Tanus-Santos JE

    更新日期:2005-08-01 00:00:00

  • Haplotypes of variants in the UDP-glucuronosyltransferase1A9 and 1A1 genes.

    abstract:OBJECTIVES:Nine different functional UGT1A enzymes are generated from a single UGT1A gene by alternative splicing, with each enzyme having a unique exon 1. SN-38, the active metabolite of the anticancer agent irinotecan, is metabolized by both UGT1A1 and UGT1A9. We aim to characterize the UGT1A9-UGT1A1 haplotypes in As...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/01213011-200505000-00004

    authors: Innocenti F,Liu W,Chen P,Desai AA,Das S,Ratain MJ

    更新日期:2005-05-01 00:00:00

  • Ethanol intake and ethanol-induced locomotion and locomotor sensitization in Cyp2e1 knockout mice.

    abstract:OBJECTIVES:It has been shown that acetaldehyde is an active metabolite of ethanol with central actions that modulate behavior. Catalase has been proposed as the main enzyme responsible for the synthesis of acetaldehyde from ethanol in the brain. Recent studies, however, suggest that cytochrome, in particular the isofor...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e328324e726

    authors: Correa M,Viaggi C,Escrig MA,Pascual M,Guerri C,Vaglini F,Aragon CM,Corsini GU

    更新日期:2009-03-01 00:00:00

  • Pharmacogenetic effects of 'candidate gene complexes' on stroke in the GenHAT study.

    abstract:OBJECTIVE:The aim of this study was to investigate whether there is a genotype-by-treatment interaction in patients experiencing stroke and treated with one of three antihypertensive drugs, that is chlorthalidone, amlodipine, or lisinopril. PARTICIPANTS AND METHODS:A population of 436 African Americans and 539 whites ...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0000000000000088

    authors: Sørensen IF,Vazquez AI,Irvin MR,Sørensen P,Davis BR,Ford CE,Boerwinkle E,Eckfeldt JH,Arnett DK

    更新日期:2014-11-01 00:00:00

  • Influence of ABCB1 and CYP3A5 genetic polymorphisms on the pharmacokinetics of quetiapine in healthy volunteers.

    abstract:BACKGROUND AND OBJECTIVES:Quetiapine is an atypical antipsychotic drug used to treat schizophrenia and acute episodes of mania. Quetiapine is metabolized by CYP3A enzymes including CYP3A5 and is a substrate of P-glycoprotein, an efflux drug transporter encoded by the ABCB1 gene. We assessed the effects of ABCB1 [c.1236...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0000000000000020

    authors: Kim KA,Joo HJ,Lee HM,Park JY

    更新日期:2014-01-01 00:00:00

  • Characterization of 17-dihydroexemestane glucuronidation: potential role of the UGT2B17 deletion in exemestane pharmacogenetics.

    abstract:OBJECTIVE:Exemestane is a third-generation aromatase inhibitor used in the treatment of breast cancer in postmenopausal women. Reduction to form 17-dihydroexemestane and subsequent glucuronidation to exemestane-17-O-glucuronide is a major pathway for exemestane metabolism. The goal of this study was to analyze 17-dihyd...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e32833b04af

    authors: Sun D,Chen G,Dellinger RW,Sharma AK,Lazarus P

    更新日期:2010-10-01 00:00:00

  • Evaluation of polymorphisms in the sulfonamide detoxification genes NAT2, CYB5A, and CYB5R3 in patients with sulfonamide hypersensitivity.

    abstract:OBJECTIVE:To determine whether polymorphisms in the sulfonamide detoxification genes, CYB5A (encoding cytochrome b(5)), CYB5R3 (encoding cytochrome b(5) reductase), or NAT2 (encoding N-acetyltransferase 2) were over-represented in patients with delayed sulfonamide drug hypersensitivity, compared with control patients w...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e328357a735

    authors: Sacco JC,Abouraya M,Motsinger-Reif A,Yale SH,McCarty CA,Trepanier LA

    更新日期:2012-10-01 00:00:00

  • Association of sirolimus adverse effects with m-TOR, p70S6K or Raptor polymorphisms in kidney transplant recipients.

    abstract:BACKGROUND:The mammalian target of rapamycin (m-TOR) inhibitor sirolimus is an immunosuppressive drug used in kidney transplantation. m-TOR binds with Raptor and phosphorylates p70S6 kinase, a protein involved in numerous cell signalling pathways. We examined the association of candidate polymorphisms in m-TOR, Raptor ...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1097/FPC.0b013e328357359d

    authors: Woillard JB,Kamar N,Rousseau A,Rostaing L,Marquet P,Picard N

    更新日期:2012-10-01 00:00:00

  • Polymorphisms of vitamin D receptor gene protect against the risk of head and neck cancer.

    abstract::Vitamin D has potent anti-tumour properties. Calcitriol [1,25(OH)2D3], the hormonal derivative of vitamin D3, is an antiproliferative and prodifferentiation factor for several cell types, including human squamous cells of the head and neck. Several polymorphisms of the vitamin D receptor (VDR) gene have been described...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/01213011-200503000-00004

    authors: Liu Z,Calderon JI,Zhang Z,Sturgis EM,Spitz MR,Wei Q

    更新日期:2005-03-01 00:00:00

  • Cyp3A4, Cyp3A5, and MDR-1 genetic influences on tacrolimus pharmacokinetics in renal transplant recipients.

    abstract:OBJECTIVE:The immunosuppressive drug tacrolimus requires strict therapeutic monitoring due to its narrow therapeutic index and great inter-individual variability. Cytochrome P450 3A4 (Cyp3A4) and Cyp3A5 are the most important contributors to tacrolimus metabolism while the P-glycoprotein pump (MDR-1) modulates its bioa...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/01.fpc.0000220571.20961.dd

    authors: Roy JN,Barama A,Poirier C,Vinet B,Roger M

    更新日期:2006-09-01 00:00:00

  • The UGT1A3*2 polymorphism affects atorvastatin lactonization and lipid-lowering effect in healthy volunteers.

    abstract:OBJECTIVE:We investigated whether the UGT1A3 polymorphisms play an important role in interindividual variations in atorvastatin lactonization and lipid-lowering effect. METHODS:Twenty-three healthy volunteers were administered atorvastatin 20 mg once daily for 14 days. Serum levels of lipids were measured before and 7...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e3283544085

    authors: Cho SK,Oh ES,Park K,Park MS,Chung JY

    更新日期:2012-08-01 00:00:00

  • The influence of human GSTZ1 gene haplotype variations on GSTZ1 expression.

    abstract:BACKGROUND/OBJECTIVES:The zeta-1 family isoform of GST biotransforms the investigational drug dichloroacetate (DCA) and certain other halogenated carboxylic acids. Haplotype variability in GSTZ1 influences the kinetics and, possibly, the toxicity of DCA. DCA metabolism correlates with expression of the GSTZ1 protein, s...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0000000000000129

    authors: Langaee TY,Zhong G,Li W,Hamadeh I,Solayman MH,McDonough CW,Stacpoole PW,James MO

    更新日期:2015-05-01 00:00:00

  • CYP2C9 variants as a risk modifier of NSAID-related gastrointestinal bleeding: a case-control study.

    abstract:OBJECTIVE:The aim of this study was to assess whether the CYP2C9*2 and/or *3 variants might modify the risk for NSAID-related upper gastrointestinal bleeding (UGIB) in NSAID users. PATIENTS AND METHODS:We conducted a multicenter, case-control study in which cases were patients aged more than 18 years with a diagnosis ...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0000000000000186

    authors: Figueiras A,Estany-Gestal A,Aguirre C,Ruiz B,Vidal X,Carvajal A,Salado I,Salgado-Barreira A,Rodella L,Moretti U,Ibáñez L,EMPHOGEN group.

    更新日期:2016-02-01 00:00:00

  • Polymorphisms of the luteinizing hormone/chorionic gonadotropin receptor gene: association with maldescended testes and male infertility.

    abstract:OBJECTIVE:Maldescended testes are the most common genital anomaly in newborns and are associated with testicular malignancy and infertility. As the inguinoscrotal phase of testis descent is androgen-dependent and requires integrity of the luteinizing hormone/chorionic gonadotropin receptor (LHCGR), we investigated whet...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e3282f4e98c

    authors: Simoni M,Tüttelmann F,Michel C,Böckenfeld Y,Nieschlag E,Gromoll J

    更新日期:2008-03-01 00:00:00

  • A haplotype of the methylenetetrahydrofolate reductase gene predicts poor tumor response in rectal cancer patients receiving preoperative chemoradiation.

    abstract:OBJECTIVE:The objective of the present study was to evaluate whether germline methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms as well as polymorphisms in the thymidylate synthase gene promoter, namely the variable number tandem repeat polymorphism (TS VNTR) and the intrarepeat G to C single n...

    journal_title:Pharmacogenetics and genomics

    pub_type: 临床试验,杂志文章

    doi:10.1097/01.fpc.0000230412.89973.c0

    authors: Terrazzino S,Agostini M,Pucciarelli S,Pasetto LM,Friso ML,Ambrosi A,Lisi V,Leon A,Lise M,Nitti D

    更新日期:2006-11-01 00:00:00

  • The rs13064411 polymorphism in the WDR52 gene, associated with PCSK9 levels, modifies statin-induced changes in serum total and LDL cholesterol levels.

    abstract:OBJECTIVE:Recently, the minor allele of the rs13064411A>G polymorphism in the WD repeat domain 52 (WDR52) gene was associated with increased statin-induced proprotein convertase subtilisin/kexin type 9 (PCSK9) levels and with LDL cholesterol response to statins. PCSK9 promotes LDL receptor degradation, leading to incre...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0000000000000120

    authors: de Keyser CE,Becker ML,Hofman A,Lous JJ,Uitterlinden AG,Visser LE,Stricker BH

    更新日期:2015-03-01 00:00:00

  • Use of antidepressants with pharmacogenetic prescribing guidelines in a 10-year depression cohort of adult primary care patients.

    abstract:OBJECTIVE:To describe the usage patterns of antidepressants with published CYP2D6- and CYP2C19-based prescribing guidelines among depressed primary care patients and estimate the proportion of patients taking antidepressants not recommended for them based on their CYP2C19 and CYP2D6 genotype-predicted metabolizer statu...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0000000000000406

    authors: Jessel CD,Mostafa S,Potiriadis M,Everall IP,Gunn JM,Bousman CA

    更新日期:2020-09-01 00:00:00

  • Association of COMT, MTHFR, and SLC19A1(RFC-1) polymorphisms with homocysteine blood levels and cognitive impairment in Parkinson's disease.

    abstract:INTRODUCTION:Elevated plasma homocysteine (Hcy) concentration is an independent risk factor for cardiovascular disease, and its involvement in endothelial cell dysfunction is well established. However, the role of Hcy and folate in the pathogenesis of Parkinson's disease (PD) remains controversial. OBJECTIVES:The stud...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e32835693f7

    authors: Białecka M,Kurzawski M,Roszmann A,Robowski P,Sitek EJ,Honczarenko K,Gorzkowska A,Budrewicz S,Mak M,Jarosz M,Gołąb-Janowska M,Koziorowska-Gawron E,Droździk M,Sławek J

    更新日期:2012-10-01 00:00:00

  • A novel promoter polymorphism in the human gene GNAS affects binding of transcription factor upstream stimulatory factor 1, Galphas protein expression and body weight regulation.

    abstract:OBJECTIVES:Body weight regulation is under complex control involving the central nervous system and peripheral pathways. The beta-adrenoceptor Galphas protein system plays an important role in heart rate regulation and lipid mobilization suggesting a key role for the stimulatory G protein Galphas in body weight regulat...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/FPC.0b013e3282f49964

    authors: Frey UH,Hauner H,Jöckel KH,Manthey I,Brockmeyer N,Siffert W

    更新日期:2008-02-01 00:00:00

  • Hepatocyte nuclear factor1 transcription factors are essential for the UDP-glucuronosyltransferase 1A9 promoter response to hepatocyte nuclear factor 4alpha.

    abstract::In humans, UDP-glucuronosyltransferase 1A9 is known to glucuronidate numerous lipophilic substances of pharmacological and toxicological importance. Although it has been established that individuals vary in their capacity to express this detoxification enzyme, little is known about the mechanisms that dictate the regu...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e32801112b5

    authors: Gardner-Stephen DA,Mackenzie PI

    更新日期:2007-01-01 00:00:00

  • No association between C-reactive protein gene polymorphisms and decrease of C-reactive protein serum concentration after infliximab treatment in Crohn's disease.

    abstract::We recently showed an association between the FCGR3A V/F polymorphism and the biological response [assessed on the basis of a C-reactive protein (CRP) concentration decrease] to infliximab in Crohn's disease. The CRP and FCGR3A genes are located on the same 1q23 locus. The present study aimed: (i) to exclude a linkage...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/01.fpc.0000182776.57437.d8

    authors: Willot S,Vermeire S,Ohresser M,Rutgeerts P,Paintaud G,Belaiche J,De Vos M,Van Gossum A,Franchimont D,Colombel JF,Watier H,Louis E

    更新日期:2006-01-01 00:00:00

  • Application of T cell-based transcriptomics to identify three candidate biomarkers for monitoring anti-TGFbetaR therapy.

    abstract:OBJECTIVES:The development of targeted drugs would greatly benefit from the simultaneous identification of biomarkers to determine the aspects of bioactivity, drug safety and efficacy, particularly when affecting receptor-signaling pathways. However, the establishment of appropriate systems to monitor drug-induced even...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e328335731c

    authors: Classen S,Muth C,Debey-Pascher S,Eggle D,Beyer M,Mallmann MR,Rudlowski C,Zander T,Pölcher M,Kuhn W,Lahn M,Schultze JL,Staratschek-Jox A

    更新日期:2010-03-01 00:00:00

  • Genotyping and haplotyping of CYP2C19 functional alleles on thin-film biosensor chips.

    abstract:OBJECTIVES:Numerous functional polymorphisms in the CYP2C19 gene have been identified; some alleles (e.g. CYP2C19*2 and CYP2C19*3) are associated with poor metabolism of CYP2C19 substrate drugs. Studies have found that the proportion of poor metabolizers, explained by CYP2C19*2 and CYP2C19*3, varies from less than 50% ...

    journal_title:Pharmacogenetics and genomics

    pub_type: 杂志文章

    doi:10.1097/FPC.0b013e32801152c2

    authors: Nakamoto K,Kidd JR,Jenison RD,Klaassen CD,Wan YJ,Kidd KK,Zhong XB

    更新日期:2007-02-01 00:00:00