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Muriel J, Barrachina J, Del Barco G, Carvajal C, Escorial M, Margarit C, Ballester P, Peiró AM. Impact of CYP2D6 genotype on opioid use disorder deprescription: an observational prospective study in chronic pain with sex-differences. Front Pharmacol 2023; 14:1200430. [PMID: 37324467 PMCID: PMC10264765 DOI: 10.3389/fphar.2023.1200430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: Opioid deprescription is the process of supervised tapering and safe withdrawal when a potentially inappropriate use is detected. This represents a challenge in chronic non-cancer pain (CNCP) patients who may respond differently to the procedure. Our aim was to analyze the potential impact of CYP2D6 phenotypes and sex on the clinical and safety outcomes during an opioid use disorder (OUD) tapering process. Methods: A prospective observational study was conducted on CNCP ambulatory OUD patients (cases, n = 138) who underwent a 6-month opioid dose reduction and discontinuation. Pain intensity, relief and quality of life (Visual analogue scale, VAS 0-100 mm), global activity (GAF, 0-100 scores), morphine equivalent daily dose (MEDD), analgesic drugs adverse events (AEs) and opioid withdrawal syndrome (OWS, 0-96 scores) were recorded at basal and final visits. Sex differences and CYP2D6 phenotypes (poor (PM), extensive (EM) and ultrarapid (UM) metabolizers based on CYP2D6*1, *2, *3, *4, *5, *6, *10, *17, *41, 2D6*5, 2D6 × N, 2D6*4 × 2 gene variants) were analyzed. Results: Although CYP2D6-UM consumed three-times less basal MEDD [40 (20-123) mg/day, p = 0.04], they showed the highest number of AEs [7 (6-11), p = 0.02] and opioid withdrawal symptoms (46 ± 10 scores, p = 0.01) after deprescription. This was inversely correlated with their quality of life (r = -0.604, p < 0.001). Sex-differences were evidenced with a tendency to a lower analgesic tolerability in females and lower quality of life in men. Discussion: These data support the potential benefits of CYP2D6-guided opioid deprescription, in patients with CNCP when OUD is detected. Further studies are required to understand a sex/gender interaction.
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Affiliation(s)
- Javier Muriel
- Pharmacogenetic Unit, Clinical Pharmacology Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Jordi Barrachina
- Pharmacogenetic Unit, Clinical Pharmacology Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Occupational Observatory, University Miguel Hernández, Elche, Spain
| | | | | | - Mónica Escorial
- Pharmacogenetic Unit, Clinical Pharmacology Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Occupational Observatory, University Miguel Hernández, Elche, Spain
| | - César Margarit
- Pharmacogenetic Unit, Clinical Pharmacology Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Pain Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Pura Ballester
- Pharmacogenetic Unit, Clinical Pharmacology Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Ana María Peiró
- Pharmacogenetic Unit, Clinical Pharmacology Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Pain Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
- Bioengineering Institute, Toxicology and Environmental Health, University Miguel Hernández, Elche, Spain
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Identification of a sex-stratified genetic algorithm for opioid addiction risk. THE PHARMACOGENOMICS JOURNAL 2021; 21:326-335. [PMID: 33589790 DOI: 10.1038/s41397-021-00212-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/16/2020] [Accepted: 01/20/2021] [Indexed: 11/08/2022]
Abstract
The opioid epidemic has had a devastating impact on our country, with wide-ranging effects on healthcare, corrections, employment, and social systems. Programs have been put in place for monitoring prescriptions, initiating and expanding medications for opioid use disorder, and harm reduction (i.e., naloxone distribution, needle exchanges). However, opportunities for personalization of opioid therapy based on addiction risk have been limited. The goal of the present study was to develop an objective risk assessment algorithm based on genetic markers that are correlated with opioid use disorder (OUD). A total of 180 single-nucleotide polymorphisms (SNPs) were tested in patients with and without OUD. SNPs selected for testing were associated with opioid metabolism and drug reward pathways based on previous studies. Of the 394 patients recruited, 200 had OUD and 194 served as controls without OUD but with prior opioid exposure. Logistic regression analyses stratified by sex identified ten unique SNPs in females and nine unique SNPs in males that were significantly associated with OUD. A Genetics Opioid Risk Score (GenORs) was calculated by counting the number of OUD risk-associated SNPs/genotypes for each patient. To evaluate the discrimination of the GenORs, a receiver operating characteristic (ROC) curve for each sex was generated and determined to be sensitive and specific. This represents the first published example of a sex-based genetic risk score with potential to predict OUD, and the first OUD algorithm to include opioid-associated pharmacokinetic genes.
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Balyan R, Mecoli M, Venkatasubramanian R, Chidambaran V, Kamos N, Clay S, Moore DL, Mavi J, Glover CD, Szmuk P, Vinks A, Sadhasivam S. CYP2D6 pharmacogenetic and oxycodone pharmacokinetic association study in pediatric surgical patients. Pharmacogenomics 2017; 18:337-348. [PMID: 28244808 DOI: 10.2217/pgs-2016-0183] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Oxycodone is partly metabolized to the active metabolite oxymorphone by hepatic CYP2D6 in the liver. Significant genetic variability in CYP2D6 activity affects oxymorphone formation. This study aimed to associate CYP2D6 genotype and oxycodone's metabolism. METHODS 30 children were administered oral oxycodone postoperatively. Plasma levels of oxycodone and oxymorphone, and CYP2D6 genotype were analyzed. CYP2D6 genotype and oxycodone metabolism phenotype were determined based on CYP2D6 total activity score (TAS) and metabolism phenotype: poor metabolizer (PM), intermediate metabolizer (IM), extensive metabolizer (EM) or ultrarapid metabolizer (UM). RESULTS Compared with PM/IM subjects, significantly greater oxymorphone exposure was seen in EM subjects (p = 0.02 for Cmax, p = 0.016 for AUC0-6 and p = 0.026 for AUC0-24). Similarly, higher TAS value was found to be associated with greater oxymorphone exposure. Higher conversion of oxycodone to oxymorphone was observed in EM subjects compared with PM/IM subjects (p = 0.0007 for Cmax, p = 0.001 for AUC0-6 and p = 0.004 for AUC0-24). CONCLUSION CYP2D6 phenotypes explain metabolism of oxycodone in children, and oxymorphone exposure is higher in CYP2D6 EM phenotype. Further studies are needed to predict the occurrence of adverse event and tailor oxycodone dose for a specific CYP2D6 phenotype.
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Affiliation(s)
- Rajiv Balyan
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2001, Cincinnati, OH 45229, USA.,Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Marc Mecoli
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2001, Cincinnati, OH 45229, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Raja Venkatasubramanian
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2001, Cincinnati, OH 45229, USA.,Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Vidya Chidambaran
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2001, Cincinnati, OH 45229, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Nichole Kamos
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Smokey Clay
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2001, Cincinnati, OH 45229, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - David L Moore
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2001, Cincinnati, OH 45229, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Jagroop Mavi
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2001, Cincinnati, OH 45229, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Chris D Glover
- Department of Anesthesia, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Peter Szmuk
- Department of Anesthesiology & Pain Management, University of Texas Southwestern & Children's Medical Center, Dallas, TX 75390, USA.,Outcome Research Consortium, Cleveland, OH 44195, USA
| | - Alexander Vinks
- Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Senthilkumar Sadhasivam
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2001, Cincinnati, OH 45229, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
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Baldacchino A, Crocamo C, Humphris G, Neufeind J, Frisher M, Scherbaum N, Carrà G. Decision support in addiction: The development of an e-health tool to assess and prevent risk of fatal overdose. The ORION Project. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 133:207-216. [PMID: 27393811 DOI: 10.1016/j.cmpb.2016.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 05/22/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE The application of e-health technology to the field of substance use disorders is at a relatively early stage, and methodological quality is still variable. Few have explored the extent of utilization of communication technology in exploring risk perception by patients enrolled in substance abuse services. The Overdose RIsk InfOrmatioN (ORION) project is a European Commission funded programme, aimed to develop and pilot an e-health psycho-educational tool to provide information to drug using individuals about the risks of suffering a drug overdose. METHODS In this article, we report on phase 1 (risk estimation), phase 2 (design), and phase 3 (feasibility) of the ORION project. RESULTS The development of ORION e-health tool underlined the importance of an evidence-based intervention aimed in obtaining reliable evaluation of risk. The ORION tool supported a decision making process aimed at influencing the substance users' self-efficacy and the degree to which the substance users' understand risk factors. Therefore, its innovative power consisted in translating risks combination into a clear estimation for the user who will then appear more likely to be interested in his/her risk perception. CONCLUSION Exploratory field testing and validation confirmed the next stage of evaluation, namely, collection of routine patient samples in study clinics. The associations between risk perception of overdose, engagement with the ORION tool and willingness to alter overdose risk factors, in a clinical setting across various EU member states will further confirm the ORION tool's generalisability and effectiveness.
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Affiliation(s)
- A Baldacchino
- School of Medicine, Medical and Biological Sciences Building North Haugh, University of St Andrews, Fife KY16 9AJ, United Kingdom.
| | - C Crocamo
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Via Forlanini, 2-27100 Pavia, Italy
| | - G Humphris
- School of Medicine, Medical and Biological Sciences Building North Haugh, University of St Andrews, Fife KY16 9AJ, United Kingdom
| | - J Neufeind
- School of Medicine, Medical and Biological Sciences Building North Haugh, University of St Andrews, Fife KY16 9AJ, United Kingdom; Playfield Institute, Startheden Hospital, Cupar, Fife KY15 5RR, United Kingdom
| | - M Frisher
- Faculty of Health, School of Pharmacy, Hornbeam Building, Keele, Staffordshire ST5 5BG, United Kingdom
| | - N Scherbaum
- Department of Addictive Behaviour and Addiction Medicine, LVR-Hospital Essen, Hospital of the University of Duisburg-Essen, Virchowstr. 174, 45147 Essen, Germany
| | - G Carrà
- Department of Mental Health, San Gerardo University Hospital, Via Pergolesi, 33-20900 Monza, Italy
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Organ-specific microcirculatory mass transport of oxycodone in humans: clinical implications for therapeutic use. Clin J Pain 2014; 31:206-13. [PMID: 24709626 DOI: 10.1097/ajp.0000000000000105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To begin to address the problem of heterogeneity of distribution of oxycodone (OC) in humans, we developed an organ-specific microcirculatory capillary-tissue exchange 2-compartment model for studying regional OC mass transport. MATERIALS AND METHODS The model was developed in silico. It quantifies OC's organ-specific mass transport rates, clearances and recycling, and it considers the effects of blood flow on OC's convective and diffusive transport. RESULTS What is new is the finding that OC undergoes local recycling at the level of organ-specific capillary-tissue exchange units in humans. Results indicate recycled OC occurs in sufficient amounts to function as a reusable source of circulating OC; which has important implications for OC dosing. Results show the brain, which is central to OC effects only receives about 8% of OC delivered to all organs via the microcirculation. This suggests that differential regulation of receptor binding, trafficking, internalization, or desensitization in the brain likely plays a dominant role in OC's central analgesic effects. DISCUSSION Organ-specific OC mass transport kinetics provide new information for OC dosing in pain management. The model promotes patient safety in opioid prescribing because it allows predictions to be made about the relative contribution that OC recycling makes to circulating OC levels. The model indicates that pharmacologic modulation of the microcirculation may give way to site-specific delivery of opioids in the future. Our study demonstrates that translation of bench in silico research data into clinical practice, although still challenging, is feasible and can assist in OC dose regimen design for patient safety.
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