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Muriel J, Escorial M, Carratalá C, Margarit C, Barrachina J, López A, Gallardo E, Kringen MK, Peiró AM. Use of CYP2D6 substrates and inhibitors during pain management with analgesic opioids: Drug-drug interactions that lead to lack of analgesic effectiveness. Biomed Pharmacother 2024; 176:116882. [PMID: 38876046 DOI: 10.1016/j.biopha.2024.116882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/15/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Several opioids have pharmacogenetic and drug-drug interactions which may compromise their analgesic effectiveness, but are not routinely implemented into supportive pain management. We hypothesized that CYP2D6 phenotypes and concomitant use of CYP2D6 substrates or inhibitors would correlate with opioid analgesic outcomes. MATERIALS AND METHODS An observational cross-sectional study was conducted with 263 adult chronic non cancer pain (CNCP) patients from a real-world pain unit under long-term CYP2D6-related opioid treatment (tramadol, hydromorphone, tapentadol or oxycodone). Metabolizer phenotype (ultrarapid [UM], normal [NM], intermediate [IM] or poor [PM]) was determined by the CYP2D6 genotype. The socio-demographic (sex, age, employment status), clinical (pain intensity and relief, neuropathic component, quality of life, disability, anxiety and depression), pharmacological (opioid doses and concomitant pharmacotherapy) and safety (adverse events) variables were recorded. RESULTS The whole population (66 % female, 65 (14) years old, 70 % retired and 63 % attended for low back pain) were classified as PM (5 %), IM (32 %), NM (56 %) and UM (6 %). Multiple linear and logistic regressions showed higher pain intensity and neuropathic component at younger ages when using any CYP2D6 substrate (p = 0.022) or inhibitor (p = 0.030) drug, respectively, with poorer pain relief when CYP2D6 inhibitors (p=0.030) were present. CONCLUSION The concomitant use of CYP2D6 substrates or inhibitors during opioid therapy for CNCP may result in lack of analgesic effectiveness. This aspect could be relevant for pharmacological decision making during CNCP management.
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Affiliation(s)
- J Muriel
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain
| | - M Escorial
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain; Occupational Observatory, University Miguel Hernández, Avda. de la Universidad s/n, Elche 03202, Spain
| | - C Carratalá
- Occupational Observatory, University Miguel Hernández, Avda. de la Universidad s/n, Elche 03202, Spain
| | - C Margarit
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain; Pain Unit, Dr. Balmis General University Hospital, c/ Pintor Baeza, 12, Alicante 03010, Spain
| | - J Barrachina
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain
| | - A López
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain; Occupational Observatory, University Miguel Hernández, Avda. de la Universidad s/n, Elche 03202, Spain
| | - E Gallardo
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI), Av. Infante D. Henrique, Covilhã 6201-506, Portugal
| | - M K Kringen
- Department of Psychopharmacology, Diakonhjemmet Hospital, Forskningsveien 7, Oslo 0373, Norway
| | - A M Peiró
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, c/Pintor Baeza, 12, Alicante 03010, Spain; Pain Unit, Dr. Balmis General University Hospital, c/ Pintor Baeza, 12, Alicante 03010, Spain; Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, Elche 03202, Spain.
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Kothary AS, Mahendra C, Tan M, Min Tan EJ, Hong Yi JP, Gabriella, Hui Jocelyn TX, Haruman JS, Tan Z, Lee CK, Lezhava A, Yan B, Irwanto A. Validation of a multi-gene qPCR-based pharmacogenomics panel across major ethnic groups in Singapore and Indonesia. Pharmacogenomics 2021; 22:1041-1056. [PMID: 34693729 DOI: 10.2217/pgs-2021-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: The clinical utility of pharmacogenomics (PGx) has been gaining traction alongside growing evidence that adverse drug reactions (ADRs) have significant genetic associations. Nala PGx Core® is a multi-gene qPCR-based panel of 20 allele variants, comprising 18 SNPs and two CYP2D6 copy number markers across four pharmacogenes - CYP2C9, CYP2C19, CYP2D6 and SLCO1B1. Methods: In this study, we validated the performance of Nala PGx Core® against benchmark methods, on the Singaporean and Indonesian populations. Results & conclusion: Nala PGx Core® demonstrated robust and accurate genotyping when compared with other established benchmarks. Furthermore, the panel successfully characterized alleles of clinical relevance, such as CYP2D6*10 and CYP2D6*36, across major ethnic groups present of Singapore and Indonesia, suggesting its potential for adoption in clinical workflows regionally.
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Affiliation(s)
- Anar Sanjaykumar Kothary
- Nalagenetics Pte Ltd, Singapore, 169204, Singapore.,Center for Genome Diagnostics, Genome Institute of Singapore, Agency for Science, Technology & Research (A*STAR), 138672, Singapore
| | | | - Mingchen Tan
- Nalagenetics Pte Ltd, Singapore, 169204, Singapore
| | - Eunice Jia Min Tan
- Department of Laboratory Medicine, National University Health System, 119074, Singapore
| | | | - Gabriella
- Nalagenetics Pte Ltd, Singapore, 169204, Singapore
| | | | | | - Zhihao Tan
- Nalagenetics Pte Ltd, Singapore, 169204, Singapore.,Center for Genome Diagnostics, Genome Institute of Singapore, Agency for Science, Technology & Research (A*STAR), 138672, Singapore
| | - Chun Kiat Lee
- Department of Laboratory Medicine, National University Health System, 119074, Singapore
| | - Alexander Lezhava
- Center for Genome Diagnostics, Genome Institute of Singapore, Agency for Science, Technology & Research (A*STAR), 138672, Singapore
| | - Benedict Yan
- Department of Laboratory Medicine, National University Health System, 119074, Singapore.,Stronghold Diagnostics Lab, Agency for Science, Technology & Research, 138672, Singapore
| | - Astrid Irwanto
- Nalagenetics Pte Ltd, Singapore, 169204, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, 117559, Singapore
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