Stefano Zanni, Jole Del Prete, Alessandra Capogrossi, Giuseppe Papapietro, Angela Del Cimmuto, Sergio Gazzanelli, Andrea Caronna, Carmela Protano
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引用次数: 0
Abstract
Purpose: Cigarette smoke continues to be widely used around the world and it contains several substances that can affect the pharmacokinetics and/or pharmacodynamics of medications, altering their safety and effectiveness. The aim of this systematic review was to summarize the scientific evidence regarding possible changes in the pharmacokinetics and/or pharmacodynamics of drugs induced by cigarette smoking, possible mechanisms of action and related effects.
Methods: The systematic review was performed according to the PRISMA Statement and the protocol was registered on the PROSPERO platform (CRD42023477784). Pubmed, Scopus, Web of Science databases were used. We considered observational, semi-experimental or experimental studies written in English and published between January 1, 2000, and November 13, 2024, focused on smoking subjects (healthy volunteers or patients) receiving any kind of medication. Data regarding possible modifications in drugs' pharmacokinetics and/or pharmacodynamics induced by cigarette smoking were assessed. The quality of observational studies and experimental studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale and the Jadad Scale, respectively.
Results: In total, 37 studies were included, and 31 of them showed relevant modifications in the pharmacokinetics or effects of the drugs in smokers compared to non-smokers. Most of the included studies (n = 20) investigated drugs for psychiatric or neurological disorders, showing a reduction in plasma concentration or an increase in drug clearance in smokers as well as antibiotics metronidazole and cycloserine. Besides, seven articles focused on anticancer drugs indicating an increase in drug metabolism. The remaining articles reported effects of smoking on the metabolism of other drugs, such as cardiovascular drugs, phosphodiesterase 5 inhibitors, local anesthetics and medications for musculoskeletal or chronic obstructive pulmonary diseases. Induction of the cytochrome enzyme CYP1A2 is the most common mechanism mediating the reduction of drug concentrations by cigarette smoking.
Conclusion: The results indicate an increased risk of therapeutic failure for smokers and represent further motivation to encourage smoking cessation or attention in formulating personalized therapy.
目的：香烟烟雾继续在世界范围内广泛使用，它含有几种可以影响药物的药代动力学和/或药效学的物质，改变其安全性和有效性。本系统综述的目的是总结有关吸烟引起药物药代动力学和/或药效学可能变化、可能的作用机制和相关效应的科学证据。方法：按照PRISMA声明进行系统评价，方案在PROSPERO平台注册（CRD42023477784）。使用Pubmed， Scopus， Web of Science数据库。我们考虑了2000年1月1日至2024年11月13日期间发表的以英语撰写的观察性、半实验性或实验性研究，这些研究的重点是接受任何药物治疗的吸烟受试者（健康志愿者或患者）。评估了吸烟引起的药物药代动力学和/或药效学可能改变的数据。观察性研究和实验性研究的质量分别使用纽卡斯尔-渥太华质量评估量表和Jadad量表进行评估。结果：共纳入37项研究，其中31项研究显示吸烟者的药代动力学或药物作用与不吸烟者相比有相关改变。大多数纳入的研究（n = 20）调查了用于精神或神经疾病的药物，显示吸烟者以及抗生素甲硝唑和环丝氨酸的血浆浓度降低或药物清除率增加。此外，有7篇文章关注抗癌药物，表明药物代谢增加。其余的文章报道了吸烟对其他药物代谢的影响，如心血管药物、磷酸二酯酶5抑制剂、局部麻醉剂和肌肉骨骼或慢性阻塞性肺病药物。诱导细胞色素酶CYP1A2是通过吸烟介导药物浓度降低的最常见机制。结论：结果表明吸烟者治疗失败的风险增加，并进一步鼓励戒烟或注意制定个性化治疗。
期刊介绍：
The European Journal of Clinical Pharmacology publishes original papers on all aspects of clinical pharmacology and drug therapy in humans. Manuscripts are welcomed on the following topics: therapeutic trials, pharmacokinetics/pharmacodynamics, pharmacogenetics, drug metabolism, adverse drug reactions, drug interactions, all aspects of drug development, development relating to teaching in clinical pharmacology, pharmacoepidemiology, and matters relating to the rational prescribing and safe use of drugs. Methodological contributions relevant to these topics are also welcomed.
Data from animal experiments are accepted only in the context of original data in man reported in the same paper. EJCP will only consider manuscripts describing the frequency of allelic variants in different populations if this information is linked to functional data or new interesting variants. Highly relevant differences in frequency with a major impact in drug therapy for the respective population may be submitted as a letter to the editor.
Straightforward phase I pharmacokinetic or pharmacodynamic studies as parts of new drug development will only be considered for publication if the paper involves
-a compound that is interesting and new in some basic or fundamental way, or
-methods that are original in some basic sense, or
-a highly unexpected outcome, or
-conclusions that are scientifically novel in some basic or fundamental sense.
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