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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">bekhterev</journal-id><journal-title-group><journal-title xml:lang="ru">Обозрение психиатрии и медицинской психологии имени В.М.Бехтерева</journal-title><trans-title-group xml:lang="en"><trans-title>V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2313-7053</issn><issn pub-type="epub">2713-055X</issn><publisher><publisher-name>V. M. BEKHTEREV  NATIONAL  RESEARCH  MEDICAL  CENTER  FOR  PSYCHIATRY  AND  NEUROLOGY                           OF    THE  RUSSIAN  FEDERATION   MINISTRY  OF  HEALTH</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.31363/2313-7053-2024-833</article-id><article-id custom-type="elpub" pub-id-type="custom">bekhterev-923</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ИССЛЕДОВАНИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>INVESTIGATIONS</subject></subj-group></article-categories><title-group><article-title>Сравнительный фармакогенетический анализ эффективности дисульфирама и цианамида при стабилизации ремиссии при синдроме зависимости от алкоголя: ключевая роль полиморфизма генов дофаминовой нейромедиации</article-title><trans-title-group xml:lang="en"><trans-title>Comparative pharmacogenetic study of disulfiram or cyanamide efficacy for alcohol dependence: the key role of dopamine neurotransmission gene polymorphisms</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8771-625X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кибитов</surname><given-names>А. О.</given-names></name><name name-style="western" xml:lang="en"><surname>Kibitov</surname><given-names>A. O.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Кибитов Александр Олегович, д.м.н., руководитель отделения геномики психических расстройств; ведущий научный сотрудник лаборатории клинической фармакологии аддиктивных состояний Института фармакологии им. А.В. Вальдмана</p><p>192019, г. Санкт-Петербург, ул. Бехтерева, д. 3</p><p>197022, г. Санкт-Петербург, ул. Льва Толстого, д. 6-8</p></bio><bio xml:lang="en"><p>Alexander O. Kibitov</p><p>St. Petersburg</p></bio><email xlink:type="simple">druggen@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1797-1121</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Рыбакова</surname><given-names>К. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Rybakova</surname><given-names>K. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Рыбакова Ксения Валерьевна, д.м.н., руководитель отделения терапии стационарных больных с аддиктивными расстройствами</p><p>192019, г. Санкт-Петербург, ул. Бехтерева, д. 3</p></bio><bio xml:lang="en"><p>Ksenia V. Rybakova</p><p>St. Petersburg</p></bio><email xlink:type="simple">ksenia@med122.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бродянский</surname><given-names>В. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Brodyansky</surname><given-names>V. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Бродянский Вадим Маркович, к.б.н., научный сотрудник лаборатории молекулярной генетики</p><p>Москва, Кропоткинский пер., д. 23</p></bio><bio xml:lang="en"><p>Vadim M. Brodyansky</p><p>Moscow</p></bio><email xlink:type="simple">vb2001@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бернцев</surname><given-names>В. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Berntsev</surname><given-names>V. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Бернцев Владимир Александрович, врач психиатр-нарколог, Дружносельская психиатрическая больница</p><p>Санкт-Петербург </p></bio><bio xml:lang="en"><p>Vladimir A. Berntsev</p><p>St. Petersburg</p></bio><email xlink:type="simple">berntsev@go.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9734-5344</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Скурат</surname><given-names>Е. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Skurat</surname><given-names>E. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Скурат Евгения Петровна, специалист, научный сотрудник</p><p>192019, г. Санкт-Петербург, ул. Бехтерева, д. 3</p></bio><bio xml:lang="en"><p>Evgenia P. Skurat </p><p>St. Petersburg</p></bio><email xlink:type="simple">skuratevgenia@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0529-4525</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Крупицкий</surname><given-names>Е. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Krupitsky</surname><given-names>E. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Крупицкий Евгений Михайлович: доктор медицинских наук, профессор, заместитель директора по научной работе, директор Института аддиктологии; директор Института фармакологии им. А.В. Вальдмана</p><p>192019, г. Санкт-Петербург, ул. Бехтерева, д. 3</p><p>197022, г. Санкт-Петербург, ул. Льва Толстого, д. 6-8</p></bio><bio xml:lang="en"><p>Evgeny M. Krupitsky </p><p>St. Petersburg</p></bio><email xlink:type="simple">kruenator@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева; Первый Санкт-Петербургский государственный медицинский университет им. акад. И.П. Павлова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology; Pavlov First St. Petersburg State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр психиатрии и неврологии им. В.М. Бехтерева</institution><country>Россия</country></aff><aff xml:lang="en"><institution>V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Национальный медицинский центр психиатрии и наркологии им В.М. Сербского</institution><country>Россия</country></aff><aff xml:lang="en"><institution>V.P. Serbsky National Medical Research Center for Psychiatry and Narcology</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>08</day><month>02</month><year>2024</year></pub-date><volume>58</volume><issue>1</issue><fpage>115</fpage><lpage>130</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Кибитов А.О., Рыбакова К.В., Бродянский В.М., Бернцев В.А., Скурат Е.П., Крупицкий Е.М., 2023</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="ru">Кибитов А.О., Рыбакова К.В., Бродянский В.М., Бернцев В.А., Скурат Е.П., Крупицкий Е.М.</copyright-holder><copyright-holder xml:lang="en">Kibitov A.O., Rybakova K.V., Brodyansky V.M., Berntsev V.A., Skurat E.P., Krupitsky E.M.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.bekhterevreview.com/jour/article/view/923">https://www.bekhterevreview.com/jour/article/view/923</self-uri><abstract><p>Актуальным направлением повышения эффективности терапии алкогольной зависимости (АЗ) является поиск возможностей индивидуализации терапии с применением фармакогенетических маркеров с целью стратификации пациентов для выбора наиболее оптимальной терапевтической тактики. Цель исследования: провести анализ ассоциации фармакогенетических маркеров с показателями эффективности дисульфирама и цианамида для стабилизации ремиссии у пациентов с АЗ. Материалы и методы. Фармакогенетическое исследование проведено на основе двойного слепого рандомизированного сравнительного плацебо-контролируемого клинического исследования эффективности и переносимости дисульфирама и цианамида в терапии синдрома зависимости от алкоголя. Основной показатель эффективности терапии: длительность удержания пациентов в программе терапии (в ремиссии), выбывание из программы терапии по любой причине считали негативным исходом. Вторичные показатели эффективности: время до срыва и время до рецидива. В исследование было включено 150 прошедших детоксикацию пациентов с АЗ (ср. возраст — 40,65±1,09 лет, 19,3% женщин), которые были рандомизированы в три группы терапии: дисульфирам, цианамид и плацебо. Длительность программы лечения составила 12 недель с еженедельным амбулаторным посещением исследовательского центра, все пациенты дополнительно получали стандартизованные сеансы психотерапии. Генетическая панель исследования состояла из 15-ти полиморфных локусов в 9-ти генах: рецепторы дофамина 2 (DRD2) и 4 (DRD4) типа, белок-трансмембранный переносчик дофамина (DAT), ферменты дофамин-бета-гидроксилаза (DBH) и катехол-орто-метил-трансфераза, а также ряд полиморфизмов в генах эндогенной опиоидной системы и генетического кластера фермента альдегиддегидрогеназы. Результаты. Для дисульфирама маркер DBH rs1108580 ассоциирован с большей (р=0,053, тренд), а маркер риска DRD4 48 bp — с меньшей длительностью ремиссии (р=0,006). Для цианамида маркер риска DAT VNTR 40 bp ассоциирован с меньшей длительностью ремиссии (р=0,006) и быстрым рецидивом (р=0,045). Маркер DAT rs27072 имеет эффект одновременно в двух группах, при этом направление эффекта противоположное: для цианамида маркер ассоциирован с большейдлительностью ремиссии (р= 0,082, тренд), большим временем до срыва (р=0,063, тренд) и большим временем до рецидива (р= 0,083,тренд). Для плацебо этот же маркер, напротив, ассоциирован с меньшим временем до рецидива (р=0,066, тренд). Для плацебо маркер риска DRD2rs1799732 ассоциирован с меньшей длительностью ремиссии (р= 0,001), с меньшим временем до срыва (р= 0,018) и с меньшим временем до рецидива (р= 0,001). Заключение. Выявлены предварительные фармакогенетические маркеры эффективности лечения алкогольной зависимости в генах, контролирующих дофаминэргическую нейромедиацию. После независимой валидации полученные маркеры могут быть использованы для фармакогенетической стратификации пациентов в целях выбора оптимального варианта терапии алкогольной зависимости.</p></abstract><trans-abstract xml:lang="en"><p>The actual direction of increasing the efficacy of alcohol dependence (AD) treatment is the search for opportunities for individualization of therapy using pharmacogenetic markers to stratify patients in order to select the most optimal therapeutic tactics. Aims. To test an associations of possible pharmacogenetic markers with indicators of the efficacy of disulfiram and cyanamide to stabilize remission in patients with AD. Materials and methods. A pharmacogenetic study was conducted on the basis of a double-blind, randomized, comparative, placebo-controlled clinical study of the efficacy and tolerability of disulfiram and cyanamide in the treatment of alcohol dependence syndrome. The main outcome: the duration of retention of patients in the treatment program (in remission), and withdrawal from the treatment program for any reason was considered a negative outcome. Secondary outcomes: time to relapse to alcohol use and time to recurrence to AD. 150 patients with AD (ICD-10 criteria) (av. age — 40.65±1.09 y.o., 19.3% females) were randomly assigned to one of three treatment groups (50 subjects in each): Disulfiram, Cyanamid and Placebo. All patients had weekly (12 weeks) visits to research clinic for brief counselling session. The genetic panel of the study consisted of 15 polymorphic loci in 9 genes: dopamine receptors 2 (DRD2) and 4 (DRD4) types, transmembrane dopamine transporter (DAT), enzymes dopamine-beta-hydroxylase (DBH) and catechol-ortho -methyl-transferase, as well as a two polymorphisms in the genes of the endogenous opioid system and the aldehyde dehydrogenase enzyme gene cluster.</p><p>Results. For disulfiram, the DBH rs1108580 is associated with a longer remission (p=0.053, trend), and DRD4 VNTR 48 bp is associated with a shorter remission (p=0.006). For cyanamide, DAT VNTR 40 bp was associated with shorter remission (p=0.006) and rapid recurrence to AD (p=0.045). DAT rs27072 has an effect simultaneously in two treatment groups, while the direction of the effect is opposite. For cyanamide, the marker is slightly associated with a longer remission (p = 0.082, trend), a longer time to relapse (p = 0.063, trend) and a longer time to recurrence to AD (p = 0.083, trend). For placebo, DAT rs27072, on the contrary, is associated with a shorter time to to recurrence to AD (p = 0.066, trend). For placebo, DRD2 rs1799732 was associated with a shorter remission (p = 0.001), a shorter time to relapse (p = 0.018), and a shorter time to recurrence to AD (p = 0.001). Conclusion. Preliminary pharmacogenetic markers of the efficacy of alcohol dependence treatment have been identified in genes that control dopaminergic neurotransmission. After independent validation, the obtained genetic markers may be used for pharmacogenetic stratification of patients in order to select the optimal treatment options for alcohol dependence.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>алкогольная зависимость</kwd><kwd>фармакотерапия</kwd><kwd>сенсибилизируюшая терапия</kwd><kwd>дисульфирам</kwd><kwd>цианамид</kwd><kwd>генетика</kwd><kwd>фармакогенетика</kwd><kwd>дофамин</kwd></kwd-group><kwd-group xml:lang="en"><kwd>alcohol dependence</kwd><kwd>pharmacotherapy</kwd><kwd>аversive medications</kwd><kwd>disulfiram</kwd><kwd>cyanamide</kwd><kwd>genetics</kwd><kwd>pharmacogenetics</kwd><kwd>dopamine</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Анохина И.П. 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