Effect of CYP inhibitors on the pharmacokinetics and safety of voriconazole:a systematic review and meta-analysis
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- 英文论文题名：Effect of CYP inhibitors on the pharmacokinetics and safety of voriconazole:a systematic review and meta-analysis
- 论文作者：Huixia Yang ; Ken Chen ; Shiyao Liang ; Zhanmiao Yi ; S ; D.Zhai
- 英文论文作者：Huixia Yang ; Ken Chen ; Shiyao Liang ; Zhanmiao Yi ; S ; D.Zhai ; Department of Pharmacy ; Peking University Third Hospital ; Department of Pharmacy ; Tsinghua University Yuquan Hospital ; Department of Pharmacy Administration and Clinical Pharmacy ; School of Pharmaceutical Sciences ; Peking University Health Science Center
- 年：2016
- 作者机构：Department of Pharmacy,Peking University Third Hospital;Department of Pharmacy,Tsinghua University Yuquan Hospital;Department of Pharmacy Administration and Clinical Pharmacy,School of Pharmaceutical Sciences,Peking University Health Science Center;
- 英文论文关键词：Voriconazole ; CYP450 inhibitors ; Systematic review ; Meta-analysis
- 会议召开时间：2016-09-27
- 会议录名称：中国药学会第十三届青年药学科研成果交流会论文集
- 语种：英文
- 分类号：R969.1
- 学会代码：YYWS
- 会议名称：中国药学会第十三届青年药学科研成果交流会
- 会议地点：中国江西南昌
- 主办单位：中国药学会
- 学会名称：中国药学会
- 页数：8
- 文件大小：557k
- 原文格式：O
- 会议级别：全国
摘要
Objective To systematically assess the effect of CYP450 inhibitors on the pharmacokinetics and safety of VORI.Methods:Cochrane Library,PubMed,Embase,CNKI,CBM and WanFang databases were searched up to January 26 th 2016.Meta analyses were performed with RevMan5.3,and risk ratios(RRs) and mean differences(MDs) with 95%confidence intervals(CIs) were calculated.Results:Seventeen studies were included:1 parallel RCT,5 cross-over RCTs,4 single-arm before-and-after studies,6 cohort studies and 1 case report.Compared with no-combined group,the group of VORI plus omeprazole had a significantly higher occurrence of hepatic dysfunction(RR = 4.11,95%CI 1.12-15.08,P = 0.03);however,no difference of neurologic dysfunction was found between VORI plus omeprazole and control group(RR = 5.20,95%CI0.52-52.47,P = 0.16).Similarly for the C_(min) of VORI,there was no difference between combined and no-combined omeprazole groups(MD = 0.18,95%CI 0.00-0.36,P=0.05).Pantoprazole,rabeprazole,cimetidine,erythromycin and contraceptive significantly increased the peak concentration and concentration-time curve(AUC) of VORI;however,indinavir and etravirine had no significant effect.The variation of pharmacokinetic parameters of VORI co-administeredwith esomeprazole,azithromycin and ritonavir indicated conflict effects.Conclusions:Co-administration of VORI and CYP450 inhibitors was safe except omeprazole.Although the C_(max) and AUC of VORI were increased while co-administrated with CYP450 inhibitors,no significantly effect on clinical practice was observed.
Objective To systematically assess the effect of CYP450 inhibitors on the pharmacokinetics and safety of VORI.Methods:Cochrane Library,PubMed,Embase,CNKI,CBM and WanFang databases were searched up to January 26 th 2016.Meta analyses were performed with RevMan5.3,and risk ratios(RRs) and mean differences(MDs) with 95%confidence intervals(CIs) were calculated.Results:Seventeen studies were included:1 parallel RCT,5 cross-over RCTs,4 single-arm before-and-after studies,6 cohort studies and 1 case report.Compared with no-combined group,the group of VORI plus omeprazole had a significantly higher occurrence of hepatic dysfunction(RR = 4.11,95%CI 1.12-15.08,P = 0.03);however,no difference of neurologic dysfunction was found between VORI plus omeprazole and control group(RR = 5.20,95%CI0.52-52.47,P = 0.16).Similarly for the C_(min) of VORI,there was no difference between combined and no-combined omeprazole groups(MD = 0.18,95%CI 0.00-0.36,P=0.05).Pantoprazole,rabeprazole,cimetidine,erythromycin and contraceptive significantly increased the peak concentration and concentration-time curve(AUC) of VORI;however,indinavir and etravirine had no significant effect.The variation of pharmacokinetic parameters of VORI co-administeredwith esomeprazole,azithromycin and ritonavir indicated conflict effects.Conclusions:Co-administration of VORI and CYP450 inhibitors was safe except omeprazole.Although the C_(max) and AUC of VORI were increased while co-administrated with CYP450 inhibitors,no significantly effect on clinical practice was observed.
Objective To systematically assess the effect of CYP450 inhibitors on the pharmacokinetics and safety of VORI.Methods:Cochrane Library,PubMed,Embase,CNKI,CBM and WanFang databases were searched up to January 26 th 2016.Meta analyses were performed with RevMan5.3,and risk ratios(RRs) and mean differences(MDs) with 95%confidence intervals(CIs) were calculated.Results:Seventeen studies were included:1 parallel RCT,5 cross-over RCTs,4 single-arm before-and-after studies,6 cohort studies and 1 case report.Compared with no-combined group,the group of VORI plus omeprazole had a significantly higher occurrence of hepatic dysfunction(RR = 4.11,95%CI 1.12-15.08,P = 0.03);however,no difference of neurologic dysfunction was found between VORI plus omeprazole and control group(RR = 5.20,95%CI0.52-52.47,P = 0.16).Similarly for the C_(min) of VORI,there was no difference between combined and no-combined omeprazole groups(MD = 0.18,95%CI 0.00-0.36,P=0.05).Pantoprazole,rabeprazole,cimetidine,erythromycin and contraceptive significantly increased the peak concentration and concentration-time curve(AUC) of VORI;however,indinavir and etravirine had no significant effect.The variation of pharmacokinetic parameters of VORI co-administeredwith esomeprazole,azithromycin and ritonavir indicated conflict effects.Conclusions:Co-administration of VORI and CYP450 inhibitors was safe except omeprazole.Although the C_(max) and AUC of VORI were increased while co-administrated with CYP450 inhibitors,no significantly effect on clinical practice was observed.
引文
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[3]Theuretzbacher U,Ihle F,DerendorfH.Clin Pharmacokinet 2006,45,649-663.
[4]Gothard P,Rogers TR.Voriconazole for serious fungal infections.Int J Clin Pract 2004,58,74-80.
[5]Hamada Y,Tokimatsu I,Mikamo H,Kimura M,Seki M,Takakura S,Ohmagari N,Takahashi Y,Kasahara K,Matsumoto K,Okada K,Igarashi M,Kobayashi M,Mochizuki T,Nishi Y,Tanigawara Y,Kimura T,Takesue Y.J Infect Chemother 2013,19,381-392.
[6]Owusu Obeng A,Egelund EF,Alsultan A,Peloquin CA,Johnson JA.Pharmacotherapy 2014,34,703-718.
[7]Brilggemann RJ,Alffenaar JW,Blijlevens NM Billaud EM,Kosterink JG,Verweij PE,Burger DM.Clin Infect Dis2009,48,1441-1458.
[8]Troke PF,Hockey HP,Hope WW.Antimicrob Agents Chemother 2011,55,4782-4788.
[9]Levin MD,den Hollander JG,van der Holt B,Rijnders BJ,van Vliet M,Sonneveld P,van Schaik RH.J Antimicrob Chemother 2007,60,1104-1107.
[10]Liu P,Foster G,Gandelman K Foster G,Gandelman K,LaBadie RR,Allison MJ,Gutierrez MJ,Sharma A.Antimicrob Agents Chemother 2007,51,3617-3626.
[11]Mikus G,Schowel V,Drzewinska M Rengelshausen J,Ding R,Riedel KD,Burhenne J,Weiss J,Thomsen T,Haefeli WE.Clin Pharmacol Ther 2006,80,126-135.
[12]Hozo SP,Djulbegovic B,Hozo I.BMC Med Res Methodol 2005,5,13.Published online,doi:10.1186/1471-2288-5-13.
[13]Higgins JPT,Green S(editors).Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011].The Cochrane Collaboration,2011.Available from www.cochrane-handbook.org.
[14]Stang A.Eur J Epidemiol.2010,25,603-605.
[15]Racil Z,Winterova J,Kouba M Zak P,Malaskova L,Buresova L,Toskova M,Lengerova M,Kocmanova I,Weinbergerova B,Timilsina S,Rolencova M,Cetkovsky P,Mayer J.Mycoses 2012,55,483-92.
[16]Wang T,Zhu H,Sun J Cheng X,Xie J,Dong H,Chen L,Wang X,Xing J,Dong Y.Int J Antimicrob Agents 2014,44,436-442.
[17]Wood N,Tan K,Purkins L Layton G,Hamlin J,Kleinermans D,Nichols D.Br J Clin Pharmacol 2003,56 Suppl1,56-61.
[18]Pascual A,Calandra T,Bolay S Buclin T,Bille J,Marchetti O.Clin Infect Dis 2008,46,201-211.
[19]Cojuttil P,Candoni A,Forghieri F,Isola M,Zannier ME,Bigliardi S,Luppi M,Fanin R,Pea F.Basic Clin Pharmacol Toxicol.2016,118,474-479.
[20]Dolton MJ,Ray JE,Chen SCA Ng K,Pont LG,McLachlan AJ.Antimicrob Agents Chemother 2012,56,4793^799.
[21]Purkins L,Wood N,Kleinermans D,Nichols D.Br J Clin Pharmacol 2003,56 Suppl 1,51-55.
[22]Purkins L,Wood N,Ghahramani P,Kleinermans D,Layton G,Nichols D.Br J Clin Pharmacol 2003,56,30-36.
[23]Shi HY,Yan J,Zhu WH Yang GP,Tan ZR,Wu WH,Zhou G,Chen XP,Ouyang DS.Eur J Clin Pharmacol 2010,66,1131-1136.
[24]Andrews E,Damle BD,Fang A,Foster G,Crownover P,La Badie R,Glue P.Br J Clin Pharmacol.2008,65,531-539.
[25]Purkins L,Wood N,Kleinermans D,Love ER.Br J Clin Pharmacol 2003,56 Suppl 1,62-68.
[26]Calcagno A,Baietto L,Pagani N Simiele M,Audagnotto S,D'Avolio A,De Rosa FG,Di Perri G,Bonora S.Pharmacogenomics 2014,15,1281-1286.
[27]Squibb B M.Clinical Trials.gov Identifier:NCT00833482 Available fromhttps://www.clinicaltrials.gov/ct2/show/NCT00833482?tenn=voriconazole&no_unk=Y&rslt=With&rank=5.
[28]Kakuda TN,Van Solingen-Ristea R,Aharchi F Smedt GD,Witek J,Nijs S,Vyncke V,Hoetelmans RM.J Clin Pharmacol 2013,53,41-50.
[29]Mai RS,Meng DM,Xie BL Xiao XL,Huang SQ,Cai XQ,Feng FY,Li YK,Chen WY.International Medicine and Health Guidance News 2013,19,3687-3690.
[30]Ouellet DA,Hsu J,Qian CS Locke CS,Eason CJ,Cavanaugh JH,Leonard JM,Granneman GR Br J Clin Pharmacol1998,46,111-116.