Abstract
This study aimed to investigate the influence of CYP2C9 genetic polymorphisms on the pharmacokinetics of losartan and its active metabolite, E-3174, through a systematic review and meta-analysis. Eight studies published before March 2021 were included in this study. We used PubMed, the Cochrane Library, EMBASE, and Web of Science, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data analysis was conducted through Review Manager (RevMan), version 5.3, and R software. We found that healthy volunteers with CYP2C9*2 or *3 carriers had higher area under the curve (AUC0-∞) of losartan (mean difference (MD) 0.17 ; 95% confidence intervals (CI): 0.04, 0.29) and lower AUC0-∞ of E-3174 (MD −0.35 ; 95% CI: −0.62, −0.08) than those with CYP2C9*1/*1. Subjects with CYP2C9*2 or *3 carriers showed lower maximum concentration (Cmax) of E-3174 than those with CYP2C9*1/*1 (MD −0.13 ; 95% CI: −0.17, −0.09). For half-life, subjects with CYP2C9*2 or *3 carriers had longer half-lives of losartan and E-3174 than those with CYP2C9*1/*1 (MD 0.47 h; 95% CI: 0.32, 0.61 and MD 0.68 h; 95% CI: 0.44, 0.92, respectively). This meta-analysis suggests that the pharmacokinetics of losartan and E-3174 are associated with the CYP2C9 polymorphisms
Highlights
Losartan is an angiotensin II receptor blocker (ARB) that is widely used for hypertension, heart failure, and diabetic nephropathy
This study aimed to investigate the effects of the CYP2C9 polymorphisms on the pharmacokinetic characteristics of losartan and E-3174 through systematic review and meta-analysis
*3 carriers and CYP2C9*1/*1. (a) AUC0-∞ of losartan and (b) AUC0-∞ of E-3174. This Analysis is the first meta-analysis to evaluate the effect of CYP2C9 gene polymorphisms
Summary
Losartan is an angiotensin II receptor blocker (ARB) that is widely used for hypertension, heart failure, and diabetic nephropathy. It blocks the angiotensin II type 1 (AT1) receptor. It is absorbed from the gastrointestinal tract after oral administration and undergoes substantial first-pass metabolism, resulting in a systematic bioavailability of approximately. It is metabolized to an active carboxylic acid metabolite E-3174, which has up to 40 times greater pharmacological activity than losartan [1,2]. CYP2C9 metabolizes losartan to E-3174 by oxidation of the C5-hydroxymethyl on the imidazole ring of the 5-carboxylic acid.
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