Impact of Genetic Polymorphism on Drug-Drug Interactions Involving CYP2D6

NCT03054220 | Completed

• 1 other identifier: 2016-00262
• Study Type: interventional
• Target: 34
• Locations: 0 countries
• Sites: N/A

Brief Summary

CYP2D6 is characterized by a huge variability in the general population, mainly because of genetic polymorphism and drug-drug interactions (DDIs). CYP2D6 genotype is known to have an impact on the extent of DDIs. Indeed several studies have pointed out differential DDIs extent according to CYP2D6 genotype. The terms phenoconversion and phenotype switch are both used to describe the phenomenon by which a given subject changes his phenotype to another due external influence such as DDIs. When given a sufficiently strong CYP2D6 inhibitor, the phenotype of an individual with no mutant allele (extensive metabolizer, EM) of CYP2D6 can be modified to a poor metabolizer (PM) phenotype. This vulnerability is also thought to be dependent on CYP2D6 genotype. Various combinations of alleles predict an EM genotype, which represents about 60 to 70% of the general population. The aim of the study is to determine whether the presence of genetic mutation in CYP2D6 has an impact on DDIs involving the CYP2D6 enzyme. Our interest focuses on CYP2D6 EM carriers of two fully functional alleles and carriers of one non-functional and one functional allele. In order to elucidate this question, CYP2D6 activity will be measured on healthy volunteers by administration of single low doses of dextromethorphan and tramadol in presence or not of duloxetine and paroxetine, two known CYP2D6 inhibitors.

Conditions

Healthy

Outcome Measures

Primary Outcomes (1)

• Difference in the proportion of volunteers with urinary metabolic ratio Dextromethorphan/Dextrorphan >0.3

  10 hours

Secondary Outcomes (6)

• AUC of plasmatic concentrations probe drugs (dextromethorphan and tramadol) and their metabolites and tramadol) and their metabolites in plasma

  24 hours

• Cmax of probe drugs (dextromethorphan and tramadol) and their metabolites and tramadol) and their metabolites in plasma and tramadol) and their metabolites in plasma

  24 hours

• Tmax of plasmatic concentrations probe drugs (dextromethorphan and tramadol) and their metabolites and tramadol) and their metabolites in plasma and tramadol) and their metabolites in plasma

  24 hours

• Half-life of probe drugs (dextromethorphan and tramadol) and their metabolites and tramadol) and their metabolites in plasma and tramadol) and their metabolites in plasma

  24 hours

• Clearance of probe drugs (dextromethorphan and tramadol) and their metabolites and tramadol) and their metabolites in plasma

  24 hours

Study Arms (2)

CYP2D6 gene score 1

EXPERIMENTAL

carriers of 1 fully functional and 1non functional CYP2D6 alleles

Drug: Dextromethorphan 5 MG; Drug: Tramadol 10 mg; Drug: Duloxetine 60mg; Drug: Paroxetine 20 mg

CYP2D6 gene score 2

EXPERIMENTAL

carriers of 2 fully functional CYP2D6 alleles

Drug: Dextromethorphan 5 MG; Drug: Tramadol 10 mg; Drug: Duloxetine 60mg; Drug: Paroxetine 20 mg

Interventions

Dextromethorphan 5 MG DRUG

CYP2D6 gene score 1; CYP2D6 gene score 2

Tramadol 10 mg DRUG

CYP2D6 gene score 1; CYP2D6 gene score 2

Duloxetine 60mg DRUG

CYP2D6 gene score 1; CYP2D6 gene score 2

Paroxetine 20 mg DRUG

CYP2D6 gene score 1; CYP2D6 gene score 2

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Healthy men and women
• Age 18-60 years
• Body Mass Index 18-27
• Understanding of French language and able to give a written inform consent
• CYP2D6 genotype : combination of two fully-functional (normal activity) alleles or of one fully-functional and one non-functional allele (null activity), according to table 1, without gene multiplication

You may not qualify if:

• Pregnant or breastfeeding woman
• Any pathologies, use of drugs or food that may affect CYP2D6 activity
• Regular smokers of \>5 cigarettes/day
• Renal or hepatic impairment
• Medical history of chronic alcoholism or abuse of psychoactive drugs, including opiate addiction
• Liver transplantation
• Sensitivity to any of the drugs used
• Alteration of hepatic tests more than 2x normal
• Glomerular filtration rate \< 60 ml/min/1.73m2

Sponsors & Collaborators

• Jules Desmeules: lead

MeSH Terms

Interventions

Dextromethorphan; Tramadol; Duloxetine Hydrochloride; Paroxetine

Intervention Hierarchy (Ancestors)

Morphinans; Opiate Alkaloids; Alkaloids; Heterocyclic Compounds; Heterocyclic Compounds, Bridged-Ring; Heterocyclic Compounds, 4 or More Rings; Heterocyclic Compounds, Fused-Ring; Phenanthrenes; Polycyclic Aromatic Hydrocarbons; Polycyclic Compounds; Cyclohexanols; Hexanols; Fatty Alcohols; Alcohols; Organic Chemicals; Dimethylamines; Methylamines; Amines; Lipids; Thiophenes; Sulfur Compounds; Heterocyclic Compounds, 1-Ring; Piperidines

Study Officials

• Jules A Desmeules, Pr

  HUG

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: BASIC SCIENCE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: February 6, 2017
• First Posted: February 15, 2017
• Study Start: July 1, 2016
• Primary Completion: December 1, 2018
• Study Completion: December 1, 2018
• Last Updated: April 19, 2019

Record last verified: 2019-04