Influence of CYP2C9 genetic variants on gastrointestinal bleeding associated with nonsteroidal anti-inflammatory drugs: a systematic critical review.

The existence of genetic polymorphisms in metabolizing enzymes can be regarded as one of the principal causes of interindividual variation in response to drugs and adverse reactions. In the case of enzyme CYP2C9, the presence of genetic coding variants could be considered a risk factor for suffering from gastrointestinal haemorrhages associated with the use of nonsteroidal anti-inflammatory drugs, due to a reduction in the enzyme's rate of metabolism. The aim of this study was to conduct a systematic critical review aimed at assessing whether the presence of CYP2C9*2 and CYP2C9*3 could increase the risk of suffering from gastrointestinal haemorrhages due to nonsteroidal anti-inflammatory drug use. Using MEDLINE as the data source, the search was limited to scientific studies published in English. Six studies met the inclusion criteria, whereas three reported no results because there were no homozygous mutant genotypes for CYP2C9*2 and *3 in their samples, risk of bleeding was associated by one with the presence of CYP2C9*2 and by two with the CYP2C9*3 coding variant. Some of the studies included in this review contained methodological limitations, which prevented the increased risk of suffering gastrointestinal haemorrhages due to nonsteroidal anti-inflammatory drug use from being satisfactorily linked to the presence of CYP2C9 coding variants.