New insights into the role of VKORC1 polymorphisms for optimal warfarin dose selection in Caribbean Hispanic patients through an external validation of a population PK/PD model - 05/01/24
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Abstract |
Warfarin, an oral anticoagulant, has been used for decades to prevent thromboembolic events. The complex interplay between CYP2C9 and VKORC1 genotypes on warfarin PK and PD properties is not fully understood in special sub-groups of patients. This study aimed to externally validate a population pharmacokinetic/pharmacodynamic (PK/PD) model for the effect of warfarin on international normalized ratio (INR) and to evaluate optimal dosing strategies based on the selected covariates in Caribbean Hispanic patients. INR, and CYP2C9 and VKORC1 genotypes from 138 patients were used to develop a population PK/PD model in NONMEM. The structural definition of a previously published PD model for INR was implemented. A numerical evaluation of the parameter-covariate relationship was performed. Simulations were conducted to determine optimal dosing strategies for each genotype combinations, focusing on achieving therapeutic INR levels. Findings revealed elevated IC50 for G/G, G/A, and A/A VKORC1 haplotypes (11.76, 10.49, and 9.22 mg/L, respectively), in this population compared to previous reports. The model-guided dosing analysis recommended daily warfarin doses of 3–5 mg for most genotypes to maintain desired INR levels, although subjects with combination of CYP2C9 and VKORC1 genotypes * 2/* 2-, * 2/* 3- and * 2/* 5-A/A would require only 1 mg daily. This research underscores the potential of population PK/PD modeling to inform personalized warfarin dosing in populations typically underrepresented in clinical studies, potentially leading to improved treatment outcomes and patient safety. By integrating genetic factors and clinical data, this approach could pave the way for more effective and tailored anticoagulation therapy in diverse patient groups.
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Highlights |
• | The PK/PD approach was adapted to the unique characteristics of Caribbean Hispanics. |
• | Warfarin PK/PD models with CYP2C9 genotypes as covariates were externally validated. |
• | Pharmacodynamic parameter IC50 and baseline INR vary across the VKORC1 haplotypes. |
• | Warfarin at doses of 3–5 mg/daily achieves therapeutic INR levels in most cases. |
• | A MIPD strategy was proposed for guiding warfarin therapy in Caribbean Hispanics. |
Abbreviations : PK, PD, PK/PD, INR, CYP2C9, VKORC1, VACHS, CI, OFV, IIV, RUV, GOF, NPDE, pc-VPC, SAEM, IMP, F, CL, V, MTT, Imax, IC50, DV, PRED, K-PD, MIPD, GGCX
Keywords : Warfarin, Pharmacokinetic/pharmacodynamic, VKORC1, CYP2C9, Hispanic Caribbean
Plan
Vol 170
Article 115977- janvier 2024 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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