Pharmacogenetic Issues in Thorough QT Trials

Authors: Judson, Richard S.¹; Salisbury, Benjamin A.²; Reed, Carol R.²; Ackerman, Michael J.³

Source: Molecular Diagnosis & Therapy, Volume 10, Number 3, 2006 , pp. 153-162(10)

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Abstract:

Drug-induced QT prolongation (DI-LQT), through its associated arrhythmias, is a leading cause of drugs being withdrawn from the market. As a consequence, the US FDA and other regulatory agencies are mandating that all new drugs go through a so-called `Thorough QT' (TQT) study to evaluate the potential for `QT liability', specifically the potential for a drug to cause a discernible increase in the QT interval. Several genetic factors that modulate the risk of DI-LQT have been discovered. These are genes responsible for the congenital long QT syndrome, drug metabolism genes (mainly CYP2D6 and CYP3A4), and genes in other regulatory pathways. Here, we briefly review the links between genetic variants and drug-induced QT risk, and propose approaches to consider for using pharmacogenetics in planning and analyzing TQT studies.

Keywords: Adverse drug reactions; Clinical trial design; Cytochrome P450; Genetic polymorphism; Long QT syndrome

Document Type: Research article

Affiliations: 1: 1 SpyroPharma, Guilford, Connecticut, USA 2: 2 Clinical Data, Inc., New Haven, Connecticut, USA 3: 3 Sudden Death Genomics Laboratory, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

Publication date: 2006-01-01