Effects of CYP3A5, CYP2C19, and CYP2B6 on the clinical efficacy and adverse outcomes of sibutramine therapy: A crucial role for the CYP2B6*6 allele

• CYP3A4, 3A5, 2B6, and 2C19 are involved in the metabolism of sibutramine.
• CYP2B6 and CYP2C19 polymorphisms were candidates for clinical outcomes of sibutramine.
• CYP2B6*6 allele affects weight reduction and pulse rate changes by sibutramine.

BackgroundVarious cytochrome P450 isoforms modulate sibutramine activity and influence sibutramine plasma levels and pharmacokinetics. However, there are no available data to demonstrate the association of these polymorphisms with the clinical outcomes of sibutramine administration.MethodsThis study was a sub-investigation of a 12-week, double-blind, placebo-controlled trial examining the additive effect of orlistat on sibutramine. The final analysis was restricted to 101 women who had fulfilled the protocol. We evaluated the effects of genetic polymorphisms of CYP3A5, CYP2C19 and CYP2B6 on the % weight loss and the occurrence of adverse events.ResultsThe change of pulse rate from baseline value was affected by both CYP2B6 and CYP3A5 genetic polymorphisms (P < .01 for CYP3A5 and P = .01 for CYP2B6). Both CYP2B6 and CYP3A5 showed gene–gene interactions (P < .01). After adjusting for significant variables in the backward stepwise regression model, the change of pulse rate and time-dependent weight reduction were significant only among the CYP2B6 genotypes (P = .027 and P < .01, respectively).ConclusionThe CYP2B6*6 allele influences the extent of weight reduction and pulse rate changes in patients undergoing sibutramine treatment.