Hachon Lorry, Declèves Xavier, Faucher Pauline, Carette Claire, Lloret-Linares Célia
Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Therapeutic Research Unit, Department of Internal Medicine, Paris, F-75010, France.
Inserm, UMR-S 1144 Université Paris Descartes-Paris Diderot, Variabilité de réponse aux psychotropes, Paris, France.
Obes Surg. 2017 Apr;27(4):1076-1090. doi: 10.1007/s11695-016-2535-z.
An important issue in the follow-up of patients with bariatric surgery remains to determine whether their therapeutic management should be different after surgery. In this article, we first reviewed all pharmacokinetic studies involving at least four subjects who underwent the Roux-en-Y gastric bypass (RYGB) bariatric surgery. Twenty-five publications were selected and, overall, 25 drugs were studied. Drug solubility and permeability parameters for each drug were defined using different parameters or classifications. Increased rates of oral drug absorption were predominantly observed. Conversely, drug exposure differed from one drug to another. Considering the galenic formulation and the Biopharmaceutics Classification System (BCS) class may help the prediction of oral drug exposure outcome after RYGB. We propose a strategy aiming to guide prescription and drug monitoring in patients with RYGB. But further research is clearly needed due to the unique characteristics of the bariatric population. Priority should be given to drugs that do not have clinical or biological surrogates for dose adaptation.
减肥手术后患者随访中的一个重要问题仍然是确定术后他们的治疗管理是否应该有所不同。在本文中，我们首先回顾了所有涉及至少四名接受Roux-en-Y胃旁路术（RYGB）减肥手术患者的药代动力学研究。挑选了25篇出版物，总共研究了25种药物。每种药物的药物溶解度和渗透性参数是使用不同参数或分类来定义的。主要观察到口服药物吸收率增加。相反，不同药物之间的药物暴露情况有所不同。考虑剂型和生物药剂学分类系统（BCS）类别可能有助于预测RYGB术后口服药物暴露结果。我们提出了一项旨在指导RYGB患者处方和药物监测的策略。但由于减肥人群的独特特征，显然需要进一步研究。对于没有临床或生物学替代指标用于剂量调整的药物应给予优先考虑。
