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Clinical Pharmacology & Therapeutics
Article . 2025 . Peer-reviewed
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PubMed Central
Article . 2025
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https://dx.doi.org/10.22028/d2...
Article . 2025
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A Comprehensive CYP2D6 Drug–Drug–Gene Interaction Network for Application in Precision Dosing and Drug Development

Authors: Simeon Rüdesheim; Helena Leonie Hanae Loer; Denise Feick; Fatima Zahra Marok; Laura Maria Fuhr; Dominik Selzer; Donato Teutonico; +8 Authors

A Comprehensive CYP2D6 Drug–Drug–Gene Interaction Network for Application in Precision Dosing and Drug Development

Abstract

Conducting clinical studies on drug–drug‐gene interactions (DDGIs) and extrapolating the findings into clinical dose recommendations is challenging due to the high complexity of these interactions. Here, physiologically‐based pharmacokinetic (PBPK) modeling networks present a new avenue for exploring such complex scenarios, potentially informing clinical guidelines and handling patient‐specific DDGIs at the bedside. Moreover, they provide an established framework for drug–drug interaction (DDI) submissions to regulatory agencies. The cytochrome P450 (CYP) 2D6 enzyme is particularly prone to DDGIs due to the high prevalence of genetic variation and common use of CYP2D6 inhibiting drugs. In this study, we present a comprehensive PBPK network covering CYP2D6 drug–gene interactions (DGIs), DDIs, and DDGIs. The network covers sensitive and moderate sensitive substrates, and strong and weak inhibitors of CYP2D6 according to the United States Food and Drug Administration (FDA) guidance. For the analyzed CYP2D6 substrates and inhibitors, DD(G)Is mediated by CYP3A4 and P‐glycoprotein were included. Overall, the network comprises 23 compounds and was developed based on 30 DGI, 45 DDI, and seven DDGI studies, covering 32 unique drug combinations. Good predictive performance was demonstrated for all interaction types, as reflected in mean geometric mean fold errors of 1.40, 1.38, and 1.56 for the DD(G)I area under the curve ratios as well as 1.29, 1.43, and 1.60 for DD(G)I maximum plasma concentration ratios. Finally, the presented network was utilized to calculate dose adaptations for CYP2D6 substrates atomoxetine (sensitive) and metoprolol (moderate sensitive) for clinically untested DDGI scenarios, showcasing a potential clinical application of DDGI model networks in the field of model‐informed precision dosing.

Countries
Netherlands, Germany
Keywords

ddc:500, Cytochrome P-450 CYP2D6, Drug Development, Research, Cytochrome P-450 CYP2D6 Inhibitors, Humans, 500, Drug Interactions, Precision Medicine, Models, Biological

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    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    5
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Average
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
5
Top 10%
Average
Top 10%
Green
hybrid