CYP2D6检测对阿片类药物患者预后影响的评价

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association Pub Date : 2025-08-13 DOI:10.1016/j.japh.2025.102905

Halle Brady, Max Weaver, Jordan Baye, Amanda Massmann

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引用次数: 0

摘要

背景：CYP2D6影响多种阿片类药物的代谢；然而，基因变异对疗效的临床影响在大量患者群体中证据有限。目的：本研究旨在评估CYP2D6表型对阿片类药物选择性药物基因组学（PGx）筛查人群疼痛反应的影响。方法：回顾性分析CYP2D6基因分型的住院患者，在PGx检测前24个月内至检测结果后36个月内服用可待因、曲马多、氢可酮或羟考酮。疼痛评分以10分模拟量表抽象，并根据基线疼痛评分分为3组（轻度、中度和重度）。在每次阿片类药物给药30分钟内测量基线疼痛评分。分析每次阿片类药物给药后从基线到6、12、24和48小时疼痛评分的百分比变化。吗啡毫克当量（MME）在阿片类药物服用期间平均。结果：共分析8062例患者。使用羟考酮最多（4856例，41%）。在轻度疼痛队列中，与正常代谢者（NMs）相比，代谢不良者（PMs）的疼痛评分在基线的所有时间内均显著增加（pDiscussion: CYP2D6代谢不良者的疼痛评分降低明显较少）。CYP2D6基因分型可以导致阿片类药物在疼痛管理中的有效使用，并且可能对羟考酮的疗效产生比先前研究更大的影响。PGx检测的全部含义受限于研究的回顾性性质。结论：在所有疼痛强度队列中，与NMs相比，pm的疼痛评分较基线的降低程度显著降低(p

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Evaluation of the impact of CYP2D6 testing on outcomes in patients taking opioids

Background

CYP2D6 affects metabolism of several opioids; however, the clinical impact of genetic variants on efficacy has limited evidence in large patient populations.

Objective

This study aims to assess the impact of CYP2D6 phenotype on pain response in an elective pharmacogenomics (PGx) screening population prescribed opioids.

Methods

A retrospective review was conducted on hospitalized patients with CYP2D6 genotyping, prescribed either codeine, tramadol, hydrocodone, or oxycodone within 24 months prior to PGx testing and through 36 months after results. Pain scores were abstracted on a 10-point analog scale and categorized into 3 cohorts (mild, moderate, and severe) based on their baseline pain score. Baseline pain score was measured within 30 min of each opioid dose administration. Percentage changes in pain scores from baseline to 6, 12, 24, and 48 hours following each respective opioid dose administration were analyzed. Morphine milligram equivalents (MME) were averaged amongst the days of opioid administration.

Results

A total of 8062 patients were analyzed. Oxycodone was the most administered (4856, 41%). Mild pain cohort poor metabolizers (PMs) had significant increase in pain scores compared to normal metabolizers (NMs) at all hours from baseline (P < 0.001). PMs in moderate and severe pain cohorts had significantly decreased pain score reduction than NMs at all hours from baseline (P < 0.001). PMs had significantly higher MME compared to NMs in these cohorts (15 vs. 10, P < 0.001).

Conclusion

CYP2D6 PMs had significantly less pain score reduction. CYP2D6 genotyping can lead to effective use of opioids in pain management and may display greater impact on efficacy of oxycodone than previously studied. Full implication of PGx testing is limited by the study's retrospective nature. PMs across all pain intensity cohorts had significantly less reduction in pain scores from baseline compared to NMs (P < 0.05). These results encourage further investigation into prospective pre-emptive CYP2D6 testing regarding effective pain management by optimizing opioid administration.

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来源期刊

Journal of the American Pharmacists Association 医学-药学

CiteScore

3.30

自引率

14.30%

发文量

336

审稿时长

46 days

期刊介绍： The Journal of the American Pharmacists Association is the official peer-reviewed journal of the American Pharmacists Association (APhA), providing information on pharmaceutical care, drug therapy, diseases and other health issues, trends in pharmacy practice and therapeutics, informed opinion, and original research. JAPhA publishes original research, reviews, experiences, and opinion articles that link science to contemporary pharmacy practice to improve patient care.