RESUMO
Despite its established inter-individual variability, sildenafil has been the subject of only a few pharmacogenetic investigations, with limited data regarding the genetic modulators of its pharmacokinetics. We conducted a pharmacogenetic sub-study of patients randomized to sildenafil (n=85) in the RELAX trial, which investigated the impact of high-dose sildenafil in patients with heart failure with preserved left ventricular ejection fraction (HFpEF). In the overall population, the CYP3A4 inferred phenotype appeared associated with the dose-adjusted peak concentrations of sildenafil at week 12 and week 24 (adjusted P=0.045 for repeated measures analysis), although this P-value did not meet our corrected significance threshold of 0.0167. In the more homogeneous Caucasian subgroup, this association was significant (adjusted P=0.0165 for repeated measures). Hence, CYP3A4 inferred phenotype is associated with peak sildenafil dose-adjusted concentrations in patients with HFpEF receiving high doses of sildenafil. The clinical impact of this association requires further investigation.
Assuntos
Citocromo P-450 CYP3A/genética , Genótipo , Insuficiência Cardíaca/genética , Citrato de Sildenafila/uso terapêutico , Volume Sistólico/genética , Vasodilatadores/uso terapêutico , Idoso , Tolerância ao Exercício/efeitos dos fármacos , Tolerância ao Exercício/genética , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Citrato de Sildenafila/sangue , Citrato de Sildenafila/farmacologia , Volume Sistólico/efeitos dos fármacos , Vasodilatadores/sangue , Vasodilatadores/farmacologiaRESUMO
We conducted a meta-analysis of pharmacogenomic substudies of three randomized trials conducted in patients with decompensated heart failure (HF) that were led by National Heart Lung and Blood Institute (NHLBI)-funded HF Network to test the hypothesis that candidate genes modulate net fluid loss and weight change in patients with decompensated HF treated with a furosemide-based diuretic regimen. Although none of the genetic variants previously shown to modulate the effects of loop diuretics in healthy individuals were associated with net fluid loss after 72 h of treatment, a set of rare variants in the APOL1 gene, which codes for apolipoprotein L1 (P=0.0005 in the random effects model), was associated with this end point. Moreover, a common variant in the multidrug resistance protein-4 coding gene (ABCC4, rs17268282) was associated with weight loss with furosemide use (P=0.0001). Our results suggest that both common and rare genetic variants modulate the response to a furosemide-based diuretic regimen in patients with decompensated HF.
Assuntos
Apolipoproteínas/genética , Furosemida/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Lipoproteínas HDL/genética , Proteínas Associadas à Resistência a Múltiplos Medicamentos/genética , Variantes Farmacogenômicos , Polimorfismo de Nucleotídeo Único , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Apolipoproteína L1 , Ensaios Clínicos como Assunto , Feminino , Deslocamentos de Líquidos Corporais/efeitos dos fármacos , Genótipo , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/genética , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Farmacogenética , Fenótipo , Fatores de Tempo , Resultado do Tratamento , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
It is not yet known whether healthy individuals and patients with a chronic disease have similar attitudes towards pharmacogenomics. Thus we conducted a survey of 175 healthy volunteers, 175 heart failure (HF) patients and 100 heart transplant recipients to compare their opinions on this subject. Most participants (>90%) stated that they would accept pharmacogenomic testing and expressed high hopes regarding its potential applications. Overall, interest for pharmacogenomics was shared equally among the three groups. In contrast, after adjusting for age, gender, education and income, healthy individuals were more likely to voice concerns about potential employment (P=0.008 vs HF, odds ratio (OR)=2.93, confidence interval (CI)=1.33-6.47; P=0.010 vs Transplant, OR=2.46, CI=1.24-4.90) and insurance discrimination (P=0.001 vs HF, OR=5.58, CI=2.01-15.48; P<0.001 vs Transplant, OR=4.98, CI=2.03-12.21) and were possibly more worried by confidentiality issues. These findings highlight the need for strict legislation and proper educational strategies directed at the general population to facilitate the clinical implementation of pharmacogenomics.
