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Faculty of Science, Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands; Department of Clinical Pharmacy, Wilhelmina Hospital, Assen, Netherlands
Faculty of Science, Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University
Department of Clinical Pharmacy, Wilhelmina Hospital
Mental Health Services Drenthe, Assen
Professor of Clinical Pharmacoepidemiology, Faculty of Science, Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University; Department of Clinical Pharmacy, University Medical Center, Utrecht
Reprints: Dr. Egberts, Faculty of Science, Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3508 TB Utrecht, Netherlands, fax 31-30-2539166, A.C.G.Egberts{at}pharm.uu.nl
BACKGROUND: Despite a large number of studies investigating the potential clinical relevance of CYP2D6 genotyping in preventing treatment failure (eg, insufficient efficacy and/or unacceptable adverse effects), the prevalence of patients using drugs metabolized by that isoenzyme is relatively unknown.
OBJECTIVE: To investigate the prevalence of patients in different populations using drugs metabolized by CYP2D6.
METHODS: In this cross-sectional study, 6 different patient
populations were investigated: general, general hospital, geriatric,
psychogeriatric, psychiatric, and mentally retarded. From every population,
150 adults using at least one drug were randomly selected. Primary outcome was
the prevalence of patients using at least one drug metabolized by CYP2D6. The
prevalence of patients using at least one CYP2D6 substrate in different
populations was compared with the general population using
2 statistics. Data were expressed as a relative risk
with a 95% confidence interval.
RESULTS: Patients from the general hospital (RR 1.81; 95% CI 1.26 to 2.62), geriatric patients (RR 2.16; 95% CI 1.26 to 2.62), psychogeriatric patients (RR 2.31; 95% CI 1.63 to 3.27), and psychiatric patients (RR 2.44; 95% CI 1.73 to 3.44) were treated more frequently with at least one drug metabolized by CYP2D6 compared with patients in the general population. Approximately 50% of psychiatric (52%), psychogeriatric (49%), and geriatric (46%) patients used at least one drug metabolized by CYP2D6. In total, 416 drugs metabolized by CYP2D6 were prescribed, with 257 (62%) of these classified as an antidepressant (Anatomical and Therapeutic Chemical [ATC] category N06A) or antipsychotic (ATC N05A).
CONCLUSIONS: Several patient populations (eg, psychiatric, psychogeriatric, geriatric) have a high prevalence of patients treated with at least one drug metabolized by CYP2D6. This study does not provide evidence regarding the clinical evidence of CYP2D6 genotyping, but shows that, if CYP2D6 genotyping is relevant for patient care, the highest probability of cost-effectiveness will, most likely, be in specific populations.
Key Words: antidepressants, antipsychotics, cytochrome P450 2D6
Published Online, March 6, 2007. www.theannals.com, DOI 10.1345/aph.1H482
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