Use of pharmacogenetics in bioequivalence studies to reduce sample size: an example with mirtazapine and CYP2D6

Pharmacogenomics J. 2013 Oct;13(5):452-5. doi: 10.1038/tpj.2012.29. Epub 2012 Jun 26.

Abstract

In bioequivalence studies, intra-individual variability (CV(w)) is critical in determining sample size. In particular, highly variable drugs may require enrollment of a greater number of subjects. We hypothesize that a strategy to reduce pharmacokinetic CV(w), and hence sample size and costs, would be to include subjects with decreased metabolic enzyme capacity for the drug under study. Therefore, two mirtazapine studies, two-way, two-period crossover design (n=68) were re-analysed to calculate the total CV(w) and the CV(w)s in three different CYP2D6 genotype groups (0, 1 and ≥ 2 active genes). The results showed that a 29.2 or 15.3% sample size reduction would have been possible if the recruitment had been of individuals carrying just 0 or 0 plus 1 CYP2D6 active genes, due to the lower CV(w). This suggests that there may be a role for pharmacogenetics in the design of bioequivalence studies to reduce sample size and costs, thus introducing a new paradigm for the biopharmaceutical evaluation of drug products.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antidepressive Agents, Tricyclic / administration & dosage*
  • Antidepressive Agents, Tricyclic / pharmacokinetics*
  • Cross-Over Studies
  • Cytochrome P-450 CYP2D6 / genetics*
  • Cytochrome P-450 CYP2D6 / metabolism*
  • Female
  • Genotype
  • Healthy Volunteers
  • Humans
  • Male
  • Mianserin / administration & dosage
  • Mianserin / analogs & derivatives*
  • Mianserin / pharmacokinetics
  • Mirtazapine
  • Pharmacogenetics / methods
  • Sample Size
  • Therapeutic Equivalency

Substances

  • Antidepressive Agents, Tricyclic
  • Mianserin
  • Mirtazapine
  • Cytochrome P-450 CYP2D6