Department of Internal Medicine, Division of Gastroenterohepatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
Eur Rev Med Pharmacol Sci. 2016 Mar;20(5):879-85.
Cytochrome P450 2C19 (CYP2C19) polymorphisms play an important role in the metabolism of proton pump inhibitors. Rabeprazole is primarily metabolized via non-enzymatic pathways. In this study, we determined whether rabeprazole- and pantoprazole-based eradication treatments were influenced by CYP2C19 polymorphisms.
A total of 200 patients infected with Helicobacter pylori were treated with either 40 mg of pantoprazole or 20 mg of rabeprazole plus 500 mg of clarithromycin, 1000 mg of amoxicillin twice daily for 2 weeks. CYP2C19 genotype status was determined by Polymerase Chain Reaction (PCR)-restriction-fragment-length polymorphism. The genotypes of cytochrome P450 2C19 were classified as homozigote extensive metabolizer (HomEM), heterozigote metabolizer (HetEM) and poor metabolizer (PM). The CYP2C19 genotype of all patients, the effectiveness of the treatment, the effect of the genotypic polymorphism on the treatment were assessed.
The frequencies of HotEM, HetEM, PM were 78%, 19.5% and 2.5%, respectively. 48% (n = 96) of the patients received treatment with rabeprazole and 52% (n = 104) with pantoprazole. The eradication rate was 64.7% for HomEM, 79.4% for HetEM, 100% for PM (p = 0.06). In HetEM, PM, are considered as a single group, the eradication rates were higher in patients with the HetEM and PM (HetEM+PM) genotypes than in those with the wild-type genotype (81.8 vs. 64.7% p = 0.031). Among the patients treated with rabeprazole, the eradication rates were significantly lower in those with the HomEM genotype than in those with the HetEM+PM genotypes (60% vs. 85.7% p = 0.023).
The genotypic polymorphism is effective on the rate of eradication. Eradication treatment rate with rabeprazole is influenced by CYP2C19 genotype.
细胞色素 P450 2C19（CYP2C19）多态性在质子泵抑制剂的代谢中起着重要作用。雷贝拉唑主要通过非酶途径代谢。在这项研究中，我们确定了基于雷贝拉唑和泮托拉唑的根除治疗是否受 CYP2C19 多态性的影响。
共有 200 名感染幽门螺杆菌的患者接受了 40mg 泮托拉唑或 20mg 雷贝拉唑加 500mg 克拉霉素、1000mg 阿莫西林，每日两次，治疗 2 周。CYP2C19 基因型通过聚合酶链反应（PCR）-限制性片段长度多态性确定。细胞色素 P450 2C19 的基因型分为纯合子广泛代谢型（HomEM）、杂合子代谢型（HetEM）和弱代谢型（PM）。评估了所有患者的 CYP2C19 基因型、治疗效果、基因型多态性对治疗的影响。
HomEM、HetEM、PM 的频率分别为 78%、19.5%和 2.5%。48%（n=96）的患者接受雷贝拉唑治疗，52%（n=104）的患者接受泮托拉唑治疗。HomEM 的根除率为 64.7%，HetEM 为 79.4%，PM 为 100%（p=0.06）。在 HetEM、PM 中，被认为是一个单一的组，HetEM 和 PM（HetEM+PM）基因型患者的根除率高于野生型基因型患者（81.8 比 64.7%，p=0.031）。在接受雷贝拉唑治疗的患者中，HomEM 基因型患者的根除率明显低于 HetEM+PM 基因型患者（60%比 85.7%，p=0.023）。
基因型多态性对根除率有影响。雷贝拉唑的根除治疗率受 CYP2C19 基因型的影响。
