Non-response to antiepileptic pharmacotherapy is associated with the ABCC2-24C>T polymorphism in young and adult patients with epilepsy

Objective We aimed to evaluate the association of non-response to antiepileptic pharmacotherapy with the frequency of variant alleles in the drug transporter genes ABCB1 and ABCC2 or in the CYP2C locus in young patients with epilepsy and an independent cohort of adults with drug-refractory epilepsy. Methods A total of 221 pediatric or adolescent Caucasian patients with epilepsy (1105 females; age: 14.5 +/- 6.54 years) were genotyped for nine putatively functionally relevant ABCB1, ABCC2, CYP2C8, CYP2C9, and CYP2C19 polymorphisms. In addition, 70 adult patients (35 females, age: 41.9 +/- 11.5 years) with drug-refractory epilepsy who had earlier undergone neurosurgical therapy were genotyped and partly (n = 22) investigated for hippocampal ABCB1 and ABCC2 mRNA expression. Finally, 242 healthy volunteers (1167 females, age: 27.0 +/- 6.77 years) from the same region were included as controls. Results The young cohort consisted of 103 (46.6%) responders and 118 (53.4%) non-responders to the first-line anticonvulsant Carriers of the putatively low-expression ABCC2 - 24T variant were significantly overrepresented among non-responders [odds ratio (OR) 2.15 (1.16-3.99); (P = 0.016)]. This overrepresentation was confirmed by comparing young responders with adult drug-refractory patients [OR 3.36 (1.71-6.59); P<0.001]. Conversely, ABCB1 genotype distribution did not significantly differ between young responders and non-responders or adult drug-refractory patients. Excluding patients with febrile convulsions, heterozygous CYP2C8*4 [OR 0.35 (0.13-0.95); P = 0.038] and CYP2C9*3 [OR 0.34 (0.14-0.81); P = 0.015] variant allele carriers were underrepresented among non-responders. ABCC2 - 24C > T genotype did not affect hippocampal ABCC2 expression, but was associated with increased ABCB1 expression (P = 0.034). Conclusion These data suggest a higher risk of antiepileptic drug failure in ABCC2 - 24T allele carriers possibly because of compensatory upregulation of ABCB1. Pharmacogeneilics and Genomics 19:353-362 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.