Journal
THERAPEUTIC DRUG MONITORING
Volume 34, Issue 2, Pages 232-235Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/FTD.0b013e31824aa50a
Keywords
pharmacogenetics; pharmacokinetics; raltegravir; drug disposition; therapeutic drug monitoring
Funding
- Abbott
- Boehringer-Inghelheim
- Bristol-Myers Squibb
- Gilead-Sciences
- GlaxoSmithKline (GSK)
- MSD
- Pfizer
- Janssen-Cilag
- Tibotec
- Roche
- Merck Sharp Dohme
- Abbott Laboratories
- AstraZeneca
- Roche Pharmaceuticals
- Tibotec (Johnson Johnson)
- Fundacion Investigacion y Educacion en SIDA (IES), Red de Investigacion en SIDA (RIS) [FIS-RD06/0006]
- European Union [LSHP-CT-2006-037570]
- UK Medical Research Council [G0800247]
- Medical Research Council [G0800247] Funding Source: researchfish
- MRC [G0800247] Funding Source: UKRI
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Introduction: Raltegravir (RAL) is the first in class integrase inhibitor and is licensed for administration at 400 mg twice daily. RAL pharmacokinetics are characterized by high interpatient variability and recently RAL plasma exposure has been correlated with efficacy. RAL is primarily metabolized by glucuronidation via uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) and UGT1A1*28 considered to be the main genetic variant associated with decreased UGT1A1 expression. This study investigated variability in RAL trough plasma concentrations (C-trough) in the clinical setting, the effect of UGT1A1*28 and concomitant antiretrovirals. Methods: A total of 86 patients, from Turin, Italy, and Madrid, Spain, were included in the analysis. Blood samples were obtained 10-14 hours postdose. Genotyping for UGT1A1*28 was conducted by sequencing. Results: High interpatient and intrapatient variabilities were observed; 13 patients had >3 samples available, and the median coefficient of variation was 128 (64-265). Coadministration of RAL with atazanavir (ATV, n = 9) resulted in higher raltegravir C-trough, 517 (307-2706) ng/mL when compared with patients not receiving ATV (n = 77) 223 (95-552; P = 0.02). UGT1A1*28 did not influence RAL plasma exposure. Discussion: We have documented large intersubject and intrasubject variabilities in RAL plasma concentrations and confirmed the interaction with ATV. Further studies are required to better understand the mechanisms that influence the pharmacokinetics of RAL.
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