engleski

Interaction between ABCG2 421C>A polymorphism and valproate in their effects on steady state disposition of lamotrigine in adults with epilepsy

AIMS To investigate the impact of glucuronidation enzyme (UGT1A4*3 142T>G, UGT1A4*2 70C>A, UGT2B7‐ 161 C>T) and transporter (MDR1/ABCB1 1236C>T, ABCG2 421C>A) polymorphisms on steady‐ state disposition of lamotrigine and on the lamotrigine‐ valproate interaction. METHODS Adults with epilepsy on lamotrigine monotherapy (n=131) or lamotrigine+valproate treatment (n=74) were genotyped and steady‐state lamotrigine and valproate morning troughs were determined as a part of routine therapeutic drug monitoring. RESULTS No effect of UGT and MDR1/ABCB1 polymorphisms was observed. In the entire cohort, ABCG2 421A allele had no effect however an interaction between the variant allele and valproate was observed: a) in lamotrigine‐only patients, variant allele (vs. wild type homozygosity) was independently (adjustments: age, sex, body mass index, lamotrigine dose, other polymorphisms) associated with mildly lower lamotrigine troughs (geometric means ratio, GMR=0.76, 95%CI 0.59‐0.98), whereas in lamotrigine+valproate patients it was associated with higher troughs (GMR=1.72, 95%CI 1.14‐2.62) ; b) valproate co‐ treatment was overall associated with markedly higher troughs vs. lamotrigine monotherapy (GMR=3.49, 95%CI 2.73‐4.44), but more so in variant allele carriers (GMR=5.24, 95%CI 3.38‐ 8.15) than in wild type homozygotes (GMR=2.32, 95%CI 1.89‐2.83) ; c) variant allele effects in two treatment subsets and valproate effects in two genotype subsets differed by 2.36‐ fold (95%CI 1.39‐3.67) ; d) increase in lamotrigine troughs associated with increasing valproate troughs was greater in variant allele carriers than in wild type homozygotes, i.e., variant allele effect increased with increasing valproate troughs. CONCLUSION This study is first to indicate a potentially relevant interaction between ABCG2 421C>A polymorphism and valproate in their effects on lamotrigine disposition.

ABCG2 polymorphism ; lamotrigine - valproate interaction ; epilepsy

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