May 19, 2022

A clue to an adverse drug event in children

Considering metabolic (CYP2D6) enzyme activity score and patient age may aid in determining an individual’s risk for an adverse event with administration of the anti-arrhythmic drug propafenone.

One in six children with congenital heart disease experience supraventricular tachycardia, a fast or erratic heartbeat that affects the heart’s upper chambers and which can be treated with the anti-arrhythmic drug propafenone.  

In adults, poor metabolism of propafenone by the CYP2D6 family of drug metabolizing enzymes is associated with adverse events (AEs) including abnormal heart rhythms. 

In a retrospective observational study of data from Vanderbilt University Medical Center’s biobank, BioVU, and linked electronic health records, Sudeep D. Sunthankar, MD, Sara Van Driest, MD, PhD, and colleagues investigated the relationship between CYP2D6 activity and propafenone AEs in pediatric and young adult patients. 

This study, published recently in Clinical and Translational Science, provides the first evidence of an association between lower CYP2D6 activity scores and an increasing number of AEs and the presence of systemic AEs in this age group, particularly in those older than 1 year. 

The authors suggest future directions include larger and more heterogeneous populations to further understand this association. 

This project was supported in part by National Institute of Health grants HL105334 and HD106446 and by the Burroughs Wellcome Fund.