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CNS Drugs
Erschienen in: CNS Drugs 2/2007

01.02.2007 | Review Article

Various Pharmacogenetic Aspects of Antiepileptic Drug Therapy

A Review

verfasst von: Dr Michael W. Mann, Gerard Pons

Erschienen in: CNS Drugs | Ausgabe 2/2007

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Abstract

Pharmacogenetics concerns the influence of an individual’s genetic background on the pharmacokinetics and pharmacodynamics of xenobiotics.
Much of the pharmacogenetic data in the field of epilepsy deals with the pharmacokinetics of antiepileptic drugs (AEDs). In particular, two polymorphisms of cytochrome P450 2C9 are known to slow down the metabolism of phenytoin to a degree that increases the risk of the neurotoxic adverse effects of this drug among carriers of these polymorphisms. A significant number of patients with epilepsy do not respond to AEDs and such pharmacoresistance is a major, largely unsolved, problem that is likely to be multifactorial in nature. In this regard, genetic factors may influence transmembrane drug transporter proteins, thereby modifying the intracerebral penetration of AEDs.
Monogenic idiopathic epilepsies are rare and frequently associated with ion channel mutations; however, to date, a consistent relationship between changes in channel properties and clinical phenotype has not been established nor has any association between genotype and response to specific treatment options. Polymorphisms of drug targets may represent another genetic facet in epilepsy: a recent study demonstrated for the first time a polymorphism of a drug target (the α-subunit of a voltage-gated sodium channel) associated in clinical practice with differing response to two classic AEDs.
Adverse drug reactions and teratogenicity of AEDs remain a major concern. Whole-genome single nucleotide polymorphism profiling might in the future help to determine genetic predisposing factors for adverse drug reactions. Recently, in Han Chinese treated with carbamazepine and presenting with Stevens-Johnson syndrome, a strong association was found with HLA B*1502.
If genetically targeted drug development becomes more affordable/cost efficient in the near future, the development of new drugs for relatively rare diseases could become economically viable for the pharmaceutical industry. The synergy of lower trial costs and efficacy-based prescribing may reduce the cost of medical treatment for a particular disease. This hypothetical advantage of the practical use of pharmacogenetics is, however, counterbalanced by several possible dangers, including illicit data mining and the development of a human ‘genetic underclass’ with the risk of exclusion from, for example employment or health insurance, because of an ‘unfavourable’ genetic profile.
Fußnoten
1
Each number preceded by a * denotes a particular polymorphism. The increasing numbers indicate the chronological order of the description of the polymorphism. *1 or ‘1’ denotes the wild type without a mutation. *1/*1 indicates the absence of a mutation in both alleles. The mutated base can be indicated in parentheses (A = adenine, C = cytosine, G = guanine, T = thymine). In CYP2C9 this is illustrated by the replacement of A by C: A→C for *3/*3 (C/C) and *3/*1 (C/ A).
 
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Metadaten
Titel
Various Pharmacogenetic Aspects of Antiepileptic Drug Therapy
A Review
verfasst von
Dr Michael W. Mann
Gerard Pons
Publikationsdatum
01.02.2007
Verlag
Springer International Publishing
Erschienen in
CNS Drugs / Ausgabe 2/2007
Print ISSN: 1172-7047
Elektronische ISSN: 1179-1934
DOI
https://doi.org/10.2165/00023210-200721020-00005

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