Pharmacogenetic study of deferasirox, an iron chelating agent

PLoS One. 2013 May 30;8(5):e64114. doi: 10.1371/journal.pone.0064114. Print 2013.

Abstract

Transfusion-associated iron overload induces systemic toxicity. Deferasirox, a convenient long acting oral agent, has recently been introduced in clinical practice with a promising efficacy. But there are some patients who experience drug-related toxicities and cannot tolerate it. To investigate effect of genetic variations on the toxicities and find optimal target population, we analyzed the genetic polymorphisms of UDP-glucuronosyltransferase 1A (UGT1A) subfamily, multi-drug resistance-associated protein 2 (MRP2) and breast cancer resistance protein (BCRP). A total of 20 functional genetic polymorphisms were analyzed in 98 patients who received deferasirox to reduce transfusion-induced iron overload. We retrospectively reviewed the medical records to find out the drug-related toxicities. Fifteen (15.3%) patients developed hepatotoxicity. Patients without wild-type allele carrying two MRP2 haplotypes containing -1774 del and/or -24T were at increased risk of developing hepatotoxicity compared to patients with the wild-type allele on multivariate analysis (OR = 7.17, 95% CI = 1.79-28.67, P = 0.005). Creatinine elevation was observed in 9 patients (9.2%). Body weight ≥40 kg and homozygosity for UGT1A1*6 were risk factors of creatinine elevation (OR = 8.48, 95% CI = 1.7-43.57, P = 0.010 and OR = 14.17, 95% CI = 1.34-150.35, P = 0.028). Our results indicate that functional genetic variants of enzymes to metabolize and transport deferasirox are associated with drug-related toxicities. Further studies are warranted to confirm the results as the pharmacogenetic biomarkers of deferasirox.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily G, Member 2
  • ATP-Binding Cassette Transporters / genetics
  • Adolescent
  • Benzoates / adverse effects*
  • Child
  • Child, Preschool
  • Creatinine / blood
  • Deferasirox
  • Female
  • Glucuronosyltransferase / genetics
  • Humans
  • Infant
  • Iron Chelating Agents / adverse effects*
  • Liver / drug effects
  • Male
  • Multidrug Resistance-Associated Protein 2
  • Multidrug Resistance-Associated Proteins / genetics
  • Neoplasm Proteins / genetics
  • Pharmacogenetics*
  • Polymorphism, Genetic
  • Triazoles / adverse effects*
  • Young Adult

Substances

  • ABCC2 protein, human
  • ABCG2 protein, human
  • ATP Binding Cassette Transporter, Subfamily G, Member 2
  • ATP-Binding Cassette Transporters
  • Benzoates
  • Iron Chelating Agents
  • Multidrug Resistance-Associated Protein 2
  • Multidrug Resistance-Associated Proteins
  • Neoplasm Proteins
  • Triazoles
  • Creatinine
  • Glucuronosyltransferase
  • Deferasirox

Grants and funding

This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A070001), and by a grant of the National Project for Personalized Genomic Medicine, Ministry for Health & Welfare, R.O.K. (A111218-PG02). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.