Pedersen Rasmus Steen, Nielsen Flemming, Stage Tore Bjerregaard, Vinholt Pernille Just, el Achwah Alaa Bilal, Damkier Per, Brosen Kim
Institute of Public Health, Clinical Pharmacology, University of Southern Denmark, Odense, Denmark.
Clin Exp Pharmacol Physiol. 2014 Nov;41(11):870-8. doi: 10.1111/1440-1681.12297.
The aim of the present study was to determine the impact of CYP2C1917 on the pharmacokinetics and pharmacodynamics of the active metabolite of clopidogrel and the pharmacokinetics of proguanil. Thus, we conducted an open-label two-phase cross-over study in 31 healthy male volunteers (11 CYP2C191/1, 11 CYP2C191/17 and nine CYP2C1917/17). In Phase A, the pharmacokinetics of the derivatized active metabolite of clopidogrel (CAMD) and platelet function were determined after administration of a single oral dose of 600 mg clopidogrel (Plavix; Sanofi-Avensis, Horsholm, Denmark). In Phase B, the pharmacokinetics of proguanil and its metabolites cycloguanil and 4-chlorphenylbiguanide (4-CPB) were determined in 29 of 31 subjects after a single oral dose of 200 mg proguanil given as the combination drug Malarone (GlaxoSmithKline Pharma, Brondby, Denmark). Significant correlations were found between the area under the time-concentration curve (AUC0-∞ ) of CAMD and both the absolute ADP-induced P2Y12 receptor-activated platelet aggregation (r = -0.60, P = 0.0007) and the percentage inhibition of aggregation (r = 0.59, P = 0.0009). In addition, the CYP2C1917/17 and CYP2C191/17 genotype groups had significantly higher percentage inhibition of platelet aggregation compared with the CYP2C191/1 subjects (geometric mean percentage inhibition of 84%, 73% and 63%, respectively; P = 0.014). Neither the absolute ADP-induced P2Y12 receptor-activated platelet aggregation, exposure to CAMD nor the pharmacokinetic parameters of proguanil, cycloguanil and 4-CPB exhibited any significant differences among the genotype groups. In conclusion, carriers of CYP2C1917 exhibit higher percentage inhibition of platelet aggregation, but do not have significantly lower absolute P2Y12 receptor-activated platelet aggregation or higher exposure to the active metabolite after a single oral administration of 600 mg clopidogrel.
本研究的目的是确定CYP2C1917对氯吡格雷活性代谢物的药代动力学和药效学以及氯胍药代动力学的影响。因此,我们在31名健康男性志愿者(11名CYP2C191/1、11名CYP2C191/17和9名CYP2C1917/17)中进行了一项开放标签的两阶段交叉研究。在A阶段,给予单次口服600mg氯吡格雷(波立维;赛诺菲-安万特,丹麦霍斯霍尔姆)后,测定氯吡格雷衍生化活性代谢物(CAMD)的药代动力学和血小板功能。在B阶段,在31名受试者中的29名单次口服200mg作为联合药物百乐眠(葛兰素史克制药,丹麦布隆德比)的氯胍后,测定氯胍及其代谢物环氯胍和4-氯苯基双胍(4-CPB)的药代动力学。发现CAMD的时间-浓度曲线下面积(AUC0-∞)与绝对ADP诱导的P2Y12受体激活的血小板聚集(r = -0.60,P = 0.0007)和聚集抑制百分比(r = 0.59,P = 0.0009)之间存在显著相关性。此外,与CYP2C191/1受试者相比,CYP2C1917/17和CYP2C191/17基因型组的血小板聚集抑制百分比显著更高(几何平均抑制百分比分别为84%、73%和63%;P = 0.014)。在各基因型组中,绝对ADP诱导的P2Y12受体激活的血小板聚集、CAMD暴露以及氯胍、环氯胍和4-CPB的药代动力学参数均未表现出任何显著差异。总之,CYP2C1917携带者表现出更高的血小板聚集抑制百分比,但在单次口服600mg氯吡格雷后,其绝对P2Y12受体激活的血小板聚集并不显著降低,活性代谢物暴露也不更高。