DAPHNE Study: Direct Anticoagulant PHarmacogeNEtic

NCT03112525 | Completed

• 1 other identifier: CCER 2016-01490
• Study Type: observational
• Target: 300
• Locations: 1 country
• Sites: 1

Brief Summary

New/direct oral anticoagulants (NOAC/DOAC), like apixaban and rivaroxaban, are an interesting alternative to unfractionated or low molecular weight heparin relayed by oral anti-vitamin K anticoagulants (VKA) for the treatment of venous thromboembolism and atrial fibrillation. This new generation of anticoagulants directly inhibit a factor in the blood coagulation pathway and have a wide therapeutic range overcoming several practical issues associated with VKA therapy including the need of routine coagulation monitoring potentially simplifying patient management. However, despite this wide therapeutic range, a large interindividual dose variability related to factors such as age, body surface, smoking, concomitant diseases as well as differences in drug metabolism, could put susceptible patients at risk for uncontrolled bleeding. Both rivaroxaban and apixaban are cleared primarily via cytochrome P450 (CYP) mediated hepatic metabolism, mainly CYP3A, and renal excretion, involving the P-glycoprotein (P-gp). Both CYP3A and P-gp activity show important interindividual variations due to drug interactions and/or genetic polymorphisms in corresponding genes. The aim of the current study is to evaluate the impact of cytochrome activity and relevant polymorphisms on rivaroxaban/apixaban dosage regimen or treatment efficacy in a hospital setting. The safety issue in this context is particularly relevant, since hospitalisation is linked to a modification of the patient's treatment with often an increase in the number of medications. The resulting changes in metabolism due to modified cytochrome and transporter activities could affect rivaroxaban/apixaban blood concentrations. Our central hypothesis is that genotype and/or phenotype in CYP3A4/5/7 or P-gp may influence the rivaroxaban/apixaban plasma concentration and increase the risk of thrombotic or hemorrhagic events. Thus, investigating how the patient's genotype and/or phenotype for CYP3A4/5/7 and P-gp could potentially alter the bio-disponibility of rivaroxaban and apixaban and therefore the risk to develop adverse events or inefficacy would be of particular interest.

Conditions

Anticoagulants and Bleeding Disorders

Keywords

rivaroxaban; apixaban; cytochrome; anticoagulant; transporter; polymorphism; genotyping; phenotyping

Outcome Measures

Primary Outcomes (4)

• Comparison Apixaban Area Under the Curve (AUC) according to patient CYP3A phenotype

  6 weeks

• Comparison Rivaroxaban AUC according to patient P-gp phenotype

  6 weeks

• Comparison Apixaban AUC according to patient CYP3A genotype

  6 weeks

• Comparison Rivaroxaban AUC according to patient P-gp genotype

  6 weeks

Secondary Outcomes (6)

• Comparison Apixaban AUC according to patient hepatic function

  6 weeks

• Comparison Rivaroxaban AUC according to patient hepatic function

  6 weeks

• Comparison Apixaban AUC according to patient renal function

  6 weeks

• Comparison Rivaroxaban AUC according to patient renal function

  6 weeks

• Comparison adverse event (bleeding) occurrence according to patient CYP3A phenotype

  6 weeks

Other Outcomes (1)

• Comparison bleeding management outcomes

  6 weeks

Study Arms (2)

Patient under Rivaroxaban

Diagnostic Test: CYP3A4/5 and P-gp phenotyping; Genetic: CYP3A4/5 and P-gp genotyping

Patient under Apixaban

Diagnostic Test: CYP3A4/5 and P-gp phenotyping; Genetic: CYP3A4/5 and P-gp genotyping

Interventions

CYP3A4/5 and P-gp phenotyping DIAGNOSTIC_TEST

Phenotyping using a simplified version of the Geneva cocktail

Patient under Apixaban; Patient under Rivaroxaban

CYP3A4/5 and P-gp genotyping GENETIC

Selected CYP3A4, CYP3A5, CYP3A7 and ABCB1 single nucleotide polymorphism (SNP) determination

Patient under Apixaban; Patient under Rivaroxaban

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients with atrial fibrillation, pulmonary embolism or deep-vein thrombosis, treated or on long-term prophylaxis with rivaroxaban or apixaban in a real-life clinical setting. All patients will be recruited at the Geneva University Hospitals

You may qualify if:

• Understanding of French or English language and provide signed and dated informed consent form.
• Willing to comply with all study procedures and be available for the duration of the study.
• Male or female, aged 18 years or above.
• Diagnosed with atrial fibrillation, deep-vein thrombosis or pulmonary embolism and under rivaroxaban or apixaban drug treatment.

You may not qualify if:

• Participation in a clinical study that may interfere with participation in this study.
• Under rivaroxaban or apixaban for prophylaxis of deep-vein thrombosis and pulmonary embolism in patients undergoing knee or hip replacement surgery.
• Anything that would place the individual at increased risk or preclude the individual's full compliance with or completion of the study.
• Known allergy to midazolam or to fexofenadine

Sponsors & Collaborators

• University Hospital, Geneva: lead

Study Sites (1)

HUG

Geneva, Switzerland

Location

Biospecimen

Retention: SAMPLES WITH DNA

whole blood

MeSH Terms

Conditions

Hemostatic Disorders

Condition Hierarchy (Ancestors)

Vascular Diseases; Cardiovascular Diseases; Hemorrhagic Disorders; Hematologic Diseases; Hemic and Lymphatic Diseases

Study Officials

• Jules Desmeules, Pr.

  HUG

  STUDY DIRECTOR

• Victoria Rollason

  HUG

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Pharmacologist

Study Record Dates

• First Submitted: April 7, 2017
• First Posted: April 13, 2017
• Study Start: June 28, 2017
• Primary Completion: January 7, 2021
• Study Completion: January 7, 2021
• Last Updated: September 30, 2021

Record last verified: 2021-09

Data Sharing

• IPD Sharing: Will not share

Locations

CH (1)