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Pharmacogenetic Dose Modeling Based on CYP2C19 Allelic Phenotypes

Pharmacogenetic variability in drug metabolism leads to patient vulnerability to side effects and to therapeutic failure. Our purpose was to introduce a systematic statistical methodology to estimate quantitative dose adjustments based on pharmacokinetic differences in pharmacogenetic subgroups, add...

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Autores principales: Stingl, Julia Carolin, Radermacher, Jason, Wozniak, Justyna, Viviani, Roberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9781550/
https://www.ncbi.nlm.nih.gov/pubmed/36559326
http://dx.doi.org/10.3390/pharmaceutics14122833
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author Stingl, Julia Carolin
Radermacher, Jason
Wozniak, Justyna
Viviani, Roberto
author_facet Stingl, Julia Carolin
Radermacher, Jason
Wozniak, Justyna
Viviani, Roberto
author_sort Stingl, Julia Carolin
collection PubMed
description Pharmacogenetic variability in drug metabolism leads to patient vulnerability to side effects and to therapeutic failure. Our purpose was to introduce a systematic statistical methodology to estimate quantitative dose adjustments based on pharmacokinetic differences in pharmacogenetic subgroups, addressing the concerns of sparse data, incomplete information on phenotypic groups, and heterogeneity of study design. Data on psychotropic drugs metabolized by the cytochrome P450 enzyme CYP2C19 were used as a case study. CYP2C19 activity scores were estimated, while statistically assessing the influence of methodological differences between studies, and used to estimate dose adjustments in genotypic groups. Modeling effects of activity scores in each substance as a population led to prudential predictions of adjustments when few data were available (‘shrinkage’). The best results were obtained with the regularized horseshoe, an innovative Bayesian approach to estimate coefficients viewed as a sample from two populations. This approach was compared to modeling the population of substance as normally distributed, to a more traditional “fixed effects” approach, and to dose adjustments based on weighted means, as in current practice. Modeling strategies were able to assess the influence of study parameters and deliver adjustment levels when necessary, extrapolated to all phenotype groups, as well as their level of uncertainty. In addition, the horseshoe reacted sensitively to small study sizes, and provided conservative estimates of required adjustments.
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spelling pubmed-97815502022-12-24 Pharmacogenetic Dose Modeling Based on CYP2C19 Allelic Phenotypes Stingl, Julia Carolin Radermacher, Jason Wozniak, Justyna Viviani, Roberto Pharmaceutics Article Pharmacogenetic variability in drug metabolism leads to patient vulnerability to side effects and to therapeutic failure. Our purpose was to introduce a systematic statistical methodology to estimate quantitative dose adjustments based on pharmacokinetic differences in pharmacogenetic subgroups, addressing the concerns of sparse data, incomplete information on phenotypic groups, and heterogeneity of study design. Data on psychotropic drugs metabolized by the cytochrome P450 enzyme CYP2C19 were used as a case study. CYP2C19 activity scores were estimated, while statistically assessing the influence of methodological differences between studies, and used to estimate dose adjustments in genotypic groups. Modeling effects of activity scores in each substance as a population led to prudential predictions of adjustments when few data were available (‘shrinkage’). The best results were obtained with the regularized horseshoe, an innovative Bayesian approach to estimate coefficients viewed as a sample from two populations. This approach was compared to modeling the population of substance as normally distributed, to a more traditional “fixed effects” approach, and to dose adjustments based on weighted means, as in current practice. Modeling strategies were able to assess the influence of study parameters and deliver adjustment levels when necessary, extrapolated to all phenotype groups, as well as their level of uncertainty. In addition, the horseshoe reacted sensitively to small study sizes, and provided conservative estimates of required adjustments. MDPI 2022-12-16 /pmc/articles/PMC9781550/ /pubmed/36559326 http://dx.doi.org/10.3390/pharmaceutics14122833 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Stingl, Julia Carolin
Radermacher, Jason
Wozniak, Justyna
Viviani, Roberto
Pharmacogenetic Dose Modeling Based on CYP2C19 Allelic Phenotypes
title Pharmacogenetic Dose Modeling Based on CYP2C19 Allelic Phenotypes
title_full Pharmacogenetic Dose Modeling Based on CYP2C19 Allelic Phenotypes
title_fullStr Pharmacogenetic Dose Modeling Based on CYP2C19 Allelic Phenotypes
title_full_unstemmed Pharmacogenetic Dose Modeling Based on CYP2C19 Allelic Phenotypes
title_short Pharmacogenetic Dose Modeling Based on CYP2C19 Allelic Phenotypes
title_sort pharmacogenetic dose modeling based on cyp2c19 allelic phenotypes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9781550/
https://www.ncbi.nlm.nih.gov/pubmed/36559326
http://dx.doi.org/10.3390/pharmaceutics14122833
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