Relationships of Proton Pump Inhibitor‐Induced Renal Injury with CYP2C19 Polymorphism: A Retrospective Cohort Study

CYP2C19型 埃索美拉唑 兰索拉唑 雷贝拉唑 医学 内科学 胃肠病学 回顾性队列研究 质子抑制剂泵 肾功能 药理学 奥美拉唑 细胞色素P450 新陈代谢
作者
Rika Fukui,Satoshi Noda,Yoshito Ikeda,Yuichi Sawayama,Tomohiro Terada,Yoshihisa Nakagawa,Shin–ya Morita
出处
期刊:Clinical Pharmacology & Therapeutics [Wiley]
卷期号:115 (5): 1141-1151 被引量:2
标识
DOI:10.1002/cpt.3183
摘要

Proton pump inhibitors (PPIs) have recently been reported to be linked with nephrotoxicity. PPIs are metabolized mainly or partly by cytochrome P450 2C19 (CYP2C19). However, the relationship between CYP2C19 genetic polymorphism and PPI-induced nephrotoxicity is unclear. In this study, we aimed to analyze the association between the time of occurrence of renal injury by PPIs, including lansoprazole, esomeprazole, rabeprazole, and vonoprazan, and CYP2C19 metabolizer status classified by CYP2C19 genotypes. Patients prescribed PPIs were reviewed in this retrospective cohort study. The primary outcome was the time to a 30% decrease in estimated glomerular filtration rate (eGFR) from baseline. In patients treated with lansoprazole, the time to a 30% decrease in eGFR for the CYP2C19 poor metabolizer (PM) group was significantly shorter than that for the non-PM group (hazard ratio for PM vs. non-PM, 2.43, 95% confidence interval, 1.21 to 4.87, P = 0.012). In contrast, in patients that received esomeprazole, rabeprazole, or vonoprazan, no significant differences were found in the time to a 30% decrease in eGFR between non-PM and PM groups. The adjusted hazard ratios for the time to a 30% eGFR decrease in patients treated with lansoprazole were significantly higher for CYP2C19 PM, hypertension, and a history of myocardial infarction. In conclusion, this retrospective study showed that CYP2C19 metabolizer status was associated with the time to a 30% eGFR decrease in patients treated with lansoprazole, but not with esomeprazole, rabeprazole, or vonoprazan.
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