RE: Onwards and upwards10 Oct 2024 18:04
Https://academic.oup.com/ehjcvp/article-abstract/10/6/481/7739585?redirectedFrom=PDF
CYP2C19
Cytochrome P450 2C19 (CYP2C19) is a hepatic enzyme responsible for the metabolism of mavacamten as well as many other commonly used medications.4 CYP2C19 is encoded by the CYP2C19 gene. Common loss of function variants in the CYP2C19 gene predict a decreased metabolism phenotype. Based on clinical trial evidence, the UK regulator, the Medicines and Healthcare products Regulatory Agency and the European Union regulator, The European Medicines Agency have advised that all patients should undergo CYP2C19 genotyping before commencing mavacamten therapy.3 This is because patients with a CYP2C19 poor metabolizer phenotype (which can be predicted from the presence of two CYP2C19 loss of function variants—one from each parent) have increased mavacamten exposure leading to increased risk of systolic dysfunction, a type A adverse drug reaction (otherwise known as too much of a good thing). Therefore, regulators have recommended both a lower a starting dose and a lower maximum dose of mavacamten for genetically predicted poor metabolizers.3 This testing is now available, and the first prescriptions have been issued in the UK and in the EU.
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