Purpose
This study aims to evaluate the influence of genetic polymorphisms of
CYP2D6, CYP3A5, ABCB1
, and
APOE
genes and nongenetic factors on steady-state plasma concentrations (Cpss) of donepezil and therapeutic outcomes in Thai patients with Alzheimer’s disease (AD) and vascular dementia (VAD).
Patients and methods
Eighty-five dementia patients who received donepezil for at least six months were recruited.
CYP2D6, CYP3A5, ABCB1
, and
APOE
polymorphisms were genotyped. Cpss of donepezil was measured. Association of genetic and non-genetic factors with Cpss and clinical outcomes of donepezil (cognitive function as measured by the Thai Mental State Examination score; TMSE) were determined by using univariate and multivariate analysis.
Results
Both univariate and multiple linear regression analysis indicated that only
CYP2D6*10
allele was associated with higher Cpss (
p
-value =0.029 and B =0.478,
p
-value =0.032, respectively) that might influence the clinical outcomes of donepezil. ie, TMSE (
p
-value =0.010 and B =4.527,
p
-value =0.001) and ΔTMSE (
p
-value =0.023 and B =4.107,
p
-value =0.002), especially in patients with AD. Interestingly, concomitant use of memantine was found to be associated with increased Cpss of donepezil (
p
-value =0.007 and B =0.511,
p
-value =0.014). Whereas, co-medication with antidepressant drugs attenuated clinical responses in patients with AD (TMSE: B =−2.719,
p
-value =0.013 and ΔTMSE: B =−2.348,
p
-value =0.028). Age was a significant predictor of donepezil response in VAD patients. No significant association of
CYP3A5*3, ABCB1
3435C>T or
ABCB1
1236C>T, and
APOE ε4
genotypes with Cpss or clinical outcomes of donepezil was found in this study.
Conclusion
Our results suggests that
CYP2D6*10
strongly influences Cpss and there is a trend toward better outcomes of donepezil in patients with AD. Nongenetic factors including concomitant drugs treatment might alter Cpss of donepezil or clinical outcomes.