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Cited by 4Pharmacogenetics and Drug MetabolismGenetic Associations and EpidemiologyNutrition, Genetics, and Disease

The DOI matches its Crossref record; 52 of the 52 references it cites were found in a registry or an index; none of the 45 sources its claims cite is checked for support yet.

Food Administration and Not Genetic Variants Causes Pharmacokinetic Variability of Tadalafil and Finasteride

Open access
Villapalos-García, Gonzalo, Zubiaur, Pablo, Marián-Revilla, Cristina, Soria-Chacartegui, Paula, Navares-Gómez, Marcos, Mejía-Abril, Gina, Rodríguez-Lopez, Andrea, González-Iglesias, Eva, Martín-Vílchez, Samuel, Román, Manuel, Ochoa, Dolores, Abad-Santos, Francisco·2023·Journal of Personalized Medicine

Abstract

Tadalafil and finasteride are used in combination for the management of benign prostatic hyperplasia (BPH). Genetic variations in genes involved in the metabolism and transport of tadalafil or finasteride (i.e., pharmacogenes) could affect their pharmacokinetic processes altering their drug exposure, efficacy, and toxicity. The main objective of this study was to investigate the effects of variants in pharmacogenes on the pharmacokinetics of tadalafil and finasteride. An exploratory candidate gene study involving 120 variants in 33 genes was performed with 66 male healthy volunteers from two bioequivalence clinical trials after administration of tadalafil/finasteride 5 mg/5 mg under fed or fasting conditions. Afterwards, a confirmatory study was conducted with 189 male and female volunteers receiving tadalafil 20 mg formulations in seven additional bioequivalence clinical trials. Regarding tadalafil, fed volunteers showed higher area in the time-concentration curve (AUC∞), maximum plasma concentration (Cmax), and time to reach Cmax (tmax) compared to fasting volunteers; male volunteers also showed higher AUC∞ and Cmax compared to female volunteers. Furthermore, fed volunteers presented higher finasteride AUC∞, Cmax and tmax compared to fasting individuals. Variants in ABCC3, CYP1A2, CES1, NUDT15, SLC22A1/A2 and UGT2B10 were nominally associated with pharmacokinetic variation in tadalafil and/or finasteride but did not remain significant after correction for multiple comparisons. Genetic variation did not demonstrate to clinically impact on the pharmacokinetics of finasteride and tadalafil; however, additional studies with larger sample sizes are needed to assess the effect of rare variants, such as CYP3A4*20 or *22, on tadalafil and finasteride pharmacokinetics.

Overview

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TL;DR

In healthy volunteers, food intake increased tadalafil and finasteride exposure and delayed tmax, while sex affected tadalafil pharmacokinetics. Genetic variants in candidate pharmacogenes showed only nominal associations that did not survive multiple-testing correction.

Key findings

  • Fed volunteers had higher tadalafil AUC∞/DW, Cmax/DW, and tmax than fasting volunteers: exploratory 1.4-fold AUC∞/DW (p = 0.004), Cmax/DW β = 0.122, R² = 0.162, pMV = 0.043, and 1.8-fold tmax (p < 0.001); confirmatory 1.2-fold AUC∞/DW (pMV = 0.001), 1.2-fold Cmax/DW (pMV < 0.001), and 1.5-fold tmax (pMV < 0.001).
  • Fed volunteers also had higher finasteride AUC∞/DW and tmax: 1.2-fold AUC∞/DW (p = 0.032) and 1.8-fold tmax (p < 0.001), but not higher Cmax/DW.
  • In the confirmatory tadalafil study, males had 1.2-fold higher AUC∞/DW (pMV = 0.009) and 1.2-fold higher Cmax/DW (pMV < 0.001) than females.
  • Variants in ABCC3, CYP1A2, CES1, NUDT15, SLC22A1/A2, and UGT2B10 were nominally associated with tadalafil and/or finasteride pharmacokinetic variation but did not remain significant after Bonferroni correction.

Methods

  • Exploratory candidate-gene study: 120 variants in 33 genes in 66 male healthy volunteers from two bioequivalence clinical trials of tadalafil/finasteride 5 mg/5 mg under fed or fasting conditions.
  • Confirmatory study: 189 male and female volunteers receiving tadalafil 20 mg formulations in seven additional bioequivalence clinical trials.
  • Pharmacokinetic parameters were calculated by non-compartmental analysis; drug levels were measured by HPLC-MS/MS with LLOQ 1 ng/mL; univariate tests were followed by multivariate linear regression with Bonferroni correction.

Limitations

  • The paper states the sample size was small, arbitrary, and not calculated to demonstrate associations; the population mixed biogeographical groups and trials, potentially introducing confounders; the study was descriptive and lacked efficacy/pharmacodynamic assessment in healthy volunteers.
  • The paper states candidate-gene design misses other genomic variants, and genotyping individual variants cannot identify rare alleles; larger studies and NGS/GWAS were suggested, including for rare CYP3A4 variants such as *20 or *22.
  • Evident from the text: CYP3A4 had insufficient variability for analysis, with only one CYP3A4 *1/*3 intermediate metabolizer among 66 volunteers; sex could not be analyzed in the exploratory finasteride study because of finasteride’s indications.

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Integrity signals

Registry

Crossref · 10.3390/jpm13111566

Cites

52 of 52 references verified0 citation errors · 0 not checkable

Statistics

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Figures

Figure 1 Tadalafil AUC∞/DW in clinical trials 3, 4, 5, 6, 7, 8, and 9 according to feeding conditions. * p < 0.05 after univariate and multivariate analysis.
Figure 1 Tadalafil AUC∞/DW in clinical trials 3, 4, 5, 6, 7, 8, and 9 according to feeding conditions. * p < 0.05 after univariate and multivariate analysis.CC BY · PubMed Central

Verification

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Metadata

Authors
Villapalos-García, G., Zubiaur, P., Marián-Revilla, C., Soria-Chacartegui, P., Navares-Gómez, M., Mejía-Abril, G., Rodríguez-Lopez, A., González-Iglesias, E., Martín-Vílchez, S., Román, M., Ochoa, D., & Abad-Santos, F.
Affiliations
  • Clinical Pharmacology Department, School of Medicine, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Instituto de Investigación Sanitaria La Princesa (IP), Universidad Autónoma de Madrid, 28006 Madrid, Spain
  • Hospital Universitario de La Princesa (ES)
Corresponding author
Zubiaur, Pablo
Venue
Journal of Personalized Medicine
Publisher
MDPI AG
Published
2023-10-31
Volume
13
Issue
11
Pages
1566
ISSN
2075-4426 (ISSN-L)
OpenAlex
W4388048650
Cited by
4
References
52
Citations by year
2026: 3 · 2024: 1
FWCI
0.60
Type
journal article
Language
en
Open access
Locations
  • Journal of Personalized Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Hispana (submittedVersion, cc-by)
  • Biblos-e Archivo (Universidad Autónoma de Madrid) (submittedVersion, public-domain)
Funders
  • Instituto de Salud Carlos III (ISCIII) and the European Social Fund (FI20/00090, ICI20/00131, FPI-UAM, 2021, 2022-C23.I01.P03.S0020-0000031, 09-PIN1-00015.6/2022)
  • Acción Estratégica en Salud 2017–2020, ISCIII (FI20/00090, ICI20/00131, FPI-UAM, 2021, 2022-C23.I01.P03.S0020-0000031, 09-PIN1-00015.6/2022)
  • Universidad Autónoma de Madrid, Margarita Salas contract (FI20/00090, ICI20/00131, FPI-UAM, 2021, 2022-C23.I01.P03.S0020-0000031, 09-PIN1-00015.6/2022)
  • Universidad Autónoma de Madrid (FI20/00090, ICI20/00131, FPI-UAM, 2021, 2022-C23.I01.P03.S0020-0000031, 09-PIN1-00015.6/2022)
  • Programa Investigo (NextGenerationEU funds of the Recovery and Resilience Facility) (FI20/00090, ICI20/00131, FPI-UAM, 2021, 2022-C23.I01.P03.S0020-0000031, 09-PIN1-00015.6/2022)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
Keywords
tadalafil, finasteride, pharmacokinetic variability, drug metabolism genes, genetic variants, benign prostatic hyperplasia, food effect, sex differences, ABCC3, CYP1A2, CES1, NUDT15, UGT2B10, drug metabolism, drug transport

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