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Ali S, Yukseloglu A, Ross CJ, Rosychuk RJ, Drendel AL, Manaloor R, Johnson DW, Le May S, Carleton B. Effects of pharmacogenetic profiles on pediatric pain relief and adverse events with ibuprofen and oxycodone. Pain Rep 2023; 8:e1113. [PMID: 38027465 PMCID: PMC10659733 DOI: 10.1097/pr9.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/27/2023] [Accepted: 08/10/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Individual genetic variation may influence clinical effects for pain medications. Effects of CYP2C9, CYP3A4, and CYP2D6 polymorphisms on clinical effectiveness and safety for ibuprofen and oxycodone were studied. Objective Primary objectives were to AU2 evaluate if allelic variations would affect clinical effectiveness and adverse events (AEs) occurrence. Methods This pragmatic prospective, observational cohort included children aged 4 to 16 years who were seen in a pediatric emergency department with an acute fracture and prescribed ibuprofen or oxycodone for at-home pain management. Saliva samples were obtained for genotyping of allelic variants, and daily telephone follow-up was conducted for 3 days. Pain was measured using the Faces Pain Scale-Revised. Results We included 210 children (n = 140 ibuprofen and n = 70 oxycodone); mean age was 11.1 (±SD 3.5) years, 33.8% were female. Median pain reduction on day 1 was similar between groups [ibuprofen 4 (IQR 2,4) and oxycodone 4 (IQR 2,6), P = 0.69]. Over the 3 days, the oxycodone group experienced more AE than the ibuprofen group (78.3% vs 53.2%, P < 0.001). Those with a CYP2C9*2 reduced function allele experienced less adverse events with ibuprofen compared with those with a normal functioning allele CYP2C9*1 (P = 0.003). Neither CYP3A4 variants nor CYP2D6 phenotype classification affected clinical effect or AE. Conclusion Although pain relief was similar, children receiving oxycodone experienced more AE, overall, than those receiving ibuprofen. For children receiving ibuprofen or oxycodone, pain relief was not affected by genetic variations in CYP2C9 or CYP3A4/CYP2D6, respectively. For children receiving ibuprofen, the presence of CYP2C9*2 was associated with less adverse events.
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Affiliation(s)
- Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry and Women & Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
| | - Aran Yukseloglu
- Department of Pediatrics, Faculty of Medicine & Dentistry and Women & Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
| | - Colin J. Ross
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Rhonda J. Rosychuk
- Department of Pediatrics, Faculty of Medicine & Dentistry and Women & Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, AB, Canada
| | - Amy L. Drendel
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robin Manaloor
- Department of Anaesthesiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - David W. Johnson
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Sylvie Le May
- Faculty of Nursing, Université de Montréal, CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Bruce Carleton
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Yuan LJ, Li XY, Ye F, Li XY, Li QQ, Zhong YS, Wang SY, Wang YH, Hu GX, Cai JP, Li JW. Enzymatic activity of 38 CYP2C9 genotypes on ibuprofen. Food Chem Toxicol 2023:113926. [PMID: 37406757 DOI: 10.1016/j.fct.2023.113926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Ibuprofen, a common non-steroidal anti-inflammatory drug, is used clinically for pain relief and antipyretic treatment worldwide. However, regular or long-term use of ibuprofen may lead to a series of adverse reactions, including gastrointestinal bleeding, hypertension and kidney injury. Previous studies have shown that CYP2C9 gene polymorphism plays an important role in the elimination of various drugs, which leads to the variation in drug efficacy. This study aimed to evaluate the effect of 38 CYP2C9 genotypes on ibuprofen metabolism. METHODS Thirty-eight recombinant human CYP2C9 microsomal enzymes were obtained using a frugiperda 21 insect expression system according to a previously described method. Assessment of the catalytic function of these variants was completed via a mature incubation system: 5 pmol CYP2C9*1 and 38 CYP2C9 variants recombinant human microsomes, 5 μL cytochrome B5, ibuprofen (5-1000 μM), and Tris-HCl buffer (pH 7.4). The ibuprofen metabolite contents were determined using HPLC analysis. HPLC analysis included a UV detector, Plus-C18 column, and mobile phase [50% acetonitrile and 50% water (containing 0.05% trifluoroacetic acid)]. The kinetic parameters of the CYP2C9 genotypes were obtained by Michaelis-Menten curve fitting. RESULTS The intrinsic clearance (CLint) of eight variants was not significantly different from CYP2C9*1; four CYP2C9 variants (CYP2C9*38, *44, *53 and *59) showed significantly higher CLint (increase by 35%-230%) than that of the wild-type; the remaining twenty-six variants exhibited significantly reduced CLint (reduced by 30%-99%) compared to that of the wild-type. CONCLUSION This is the first systematic evaluation of the catalytic characteristics of 38 CYP2C9 genotypes involved ibuprofen metabolism. Our results provide a corresponding supplement to studies on CYP2C9 gene polymorphisms and kinetic characteristics of different variants. We need to focus on poor metabolizers (PMs) with severely abnormal metabolic functions, because they are more susceptible to drug exposure.
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Affiliation(s)
- Ling-Jing Yuan
- Department of Pharmacy, Shaoxing Second Hospital, Shaoxing, Zhejiang, China; School of Pharmaceutical Sciences, School of Pharmacy of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiang-Yu Li
- Department of Pharmacy, Shaoxing Keqiao Women & Children΄s Hospital, Shaoxing, Zhejiang, China
| | - Feng Ye
- School of Pharmaceutical Sciences, School of Pharmacy of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xin-Yue Li
- School of Pharmaceutical Sciences, School of Pharmacy of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qing-Qing Li
- School of Pharmaceutical Sciences, School of Pharmacy of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yun-Shan Zhong
- School of Pharmaceutical Sciences, School of Pharmacy of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shi-Yu Wang
- School of Pharmaceutical Sciences, School of Pharmacy of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ya-Hui Wang
- School of Pharmaceutical Sciences, School of Pharmacy of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guo-Xin Hu
- School of Pharmaceutical Sciences, School of Pharmacy of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jian-Ping Cai
- The Ministry of Health (MOH) Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, PR China.
| | - Jun-Wei Li
- School of Pharmaceutical Sciences, School of Pharmacy of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Kusic D, Heil J, Zajic S, Brangan A, Dairo O, Smith G, Morales-Scheihing D, Buono RJ, Ferraro TN, Haroz R, Salzman M, Baston K, Bodofsky E, Sabia M, Resch A, Scheinfeldt LB. Patient Perceptions and Potential Utility of Pharmacogenetic Testing in Chronic Pain Management and Opioid Use Disorder in the Camden Opioid Research Initiative. Pharmaceutics 2022; 14:pharmaceutics14091863. [PMID: 36145611 PMCID: PMC9505214 DOI: 10.3390/pharmaceutics14091863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Pharmacogenetics (PGx) has the potential to improve opioid medication management. Here, we present patient perception data, pharmacogenetic data and medication management trends in patients with chronic pain (arm 1) and opioid use disorder (arm 2) treated at Cooper University Health Care in Camden City, NJ. Our results demonstrate that the majority of patients in both arms of the study (55% and 65%, respectively) are open to pharmacogenetic testing, and most (66% and 69%, respectively) believe that genetic testing has the potential to improve their medical care. Our results further support the potential for CYP2D6 PGx testing to inform chronic pain medication management for poor metabolizers (PMs) and ultrarapid metabolizers (UMs). Future efforts to implement PGx testing in chronic pain management, however, must address patient concerns about genetic test result access and genetic discrimination.
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Affiliation(s)
- Dara Kusic
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
| | - Jessica Heil
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
- Cooper University Health Care, Camden, NJ 08103, USA
| | - Stefan Zajic
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
- GSK, Collegeville, PA 19426, USA
| | - Andrew Brangan
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
- Geisinger, Danville, PA 17822, USA
| | - Oluseun Dairo
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Gretchen Smith
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
| | | | - Russell J. Buono
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | | | - Rachel Haroz
- Cooper University Health Care, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Matthew Salzman
- Cooper University Health Care, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Kaitlan Baston
- Cooper University Health Care, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Elliot Bodofsky
- Cooper University Health Care, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Michael Sabia
- Cooper University Health Care, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Alissa Resch
- Coriell Institute for Medical Research, Camden, NJ 08103, USA
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Real-World Impact of a Pharmacogenomics-Enriched Comprehensive Medication Management Program. J Pers Med 2022; 12:jpm12030421. [PMID: 35330421 PMCID: PMC8949247 DOI: 10.3390/jpm12030421] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
The availability of clinical decision support systems (CDSS) and other methods for personalizing medicine now allows evaluation of their real-world impact on healthcare delivery. For example, addressing issues associated with polypharmacy in older patients using pharmacogenomics (PGx) and comprehensive medication management (CMM) is thought to hold great promise for meaningful improvements across the goals of the Quadruple Aim. However, few studies testing these tools at scale, using relevant system-wide metrics, and under real-world conditions, have been published to date. Here, we document a reduction of ~$7000 per patient in direct medical charges (a total of $37 million over 5288 enrollees compared to 22,357 non-enrolled) in Medicare Advantage patients (≥65 years) receiving benefits through a state retirement system over the first 32 months of a voluntary PGx-enriched CMM program. We also observe a positive shift in healthcare resource utilization (HRU) away from acute care services and toward more sustainable and cost-effective primary care options. Together with improvements in medication risk assessment, patient/provider communication via pharmacist-mediated medication action plans (MAP), and the sustained positive trends in HRU, we suggest these results validate the use of a CDSS to unify PGx and CMM to optimize care for this and similar patient populations.
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Abdullaev SP, Denisenko NP, Mirzaev KB, Shuev GN, Sozaeva ZA, Kachanova AA, Mammaev SN, Kasaeva EA, Gafurov DM, Grishina EA, Sychev DA. CYP2C8, PTGS-1, 2 gene polymorphisms prevalence associated with sensitivity to non-steroidal anti-inflammatory drugs among North Caucasus ethnic groups. TERAPEVT ARKH 2021; 93:1334-1339. [DOI: 10.26442/00403660.2021.11.201220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 11/22/2022]
Abstract
Aim. Find the prevalence of CYP2C8*3 (rs10509681; rs11572080), PTGS-1 (rs10306135; rs12353214) and PTGS-2 (rs20417) alleles and genotypes in four ethnic groups among Laks, Avars, Dargins and Kumyks.
Materials and methods. The study involved 400 volunteers from four ethnic groups living in Republic of Dagestan: 100 participants from each group. Carriage of polymorphic markers was determined by reverse transcription polymerase chain reaction.
Results. Minor allele frequency of the CYP2C8 (rs10509681) was 5.5% in Avars, 10% in Dargins, Laks and Kumyks 6.5% both; CYP2C8 (rs11572080) was 5.5% in Avars, 9.5% in Dargins, 6.5% in Laks, 8.5% in Kumyks; PTGS-1 (rs10306135) in Avars 10.5%, in Dargins 13.0%, in Laks 9.5% and Kumyks 7.5%; PTGS-1 (rs12353214) in Avars 9.0%, in Dargins 4.5%, in Laks 7.5%, in Kumyks 8.0%; PTGS-2 (rs20417) in Avars 1.0%, in Dargins 2.5%, in Laks 3.5%, in Kumyks 5.0%. There were no significant differences between groups.
Conclusion. The study of CYP2C8 and PTGS-1 and 2 gene polymorphisms is promising for predicting the effectiveness and safety of non-steroidal anti-inflammatory drug therapy, due to the high prevalence of these polymorphisms in ethnic groups in the North Caucasus.
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Morozova TE, Shatsky DA, Shikh NV, Shikh EV, Andrushchyshina TB, Lukina MV, Kachanova AA, Sozaeva ZA, Shuev GN, Denisenko NP, Grishina EА, Sychev DA. Pharmacogenetic Aspects of Postoperative Anesthesia with Ketoprofen in Cardiac Surgery Patients. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-10-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. Evaluation of the effect of polymorphisms of the CYP2D6, CYP2C8 genes on the efficacy and safety of postoperative analgesia with ketoprofen in patients with coronary artery disease after cardiac surgery.Material and methods. The study included 90 patients with an established diagnosis of coronary artery disease and postoperative period after cardiac surgery. Patients received ketoprofen 100 mg intramuscularly 2 times a day for 5 days. The intensity of pain was rated by Numeric Rating Scale. The severity of dyspepsia was assessed by the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. DNA was isolated from venous blood using an automated system. Single nucleotide polymorphisms CYP2C8 (C>T) rs11572080, CYP2D6*4 (1846G>A) rs3892097 were determined by the real-time polymerase chain reaction method.Results. In patients with genotypes GA and GG for the allelic variant CYP2D6*4, significant differences in the intensity of pain syndrome were found on days 4 and 5 of the postoperative period: 3,91±2,17 and 4,95±1,8 points (p=0,04), 3,52±1,95 and 4,5±1,7 points (p=0,04) in patients with GA and GG genotypes on days 4 and 5, respectively. In patients with the CT genotype for the CYP2C8 rs11572080, the severity of dyspepsia by GSRS was significantly higher than in patients with the CC genotype: 22,67±7,64 and 18,97±4,25 points, respectively.Conclusion. Patients with the GA genotype for the CYP2D6*4 allelic variant showed a lower intensity of pain syndrome than the GG genotype. In patients with the CT genotype for the CYP2C8 rs11572080, higher dyspepsia was revealed than in the CC genotype.
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Affiliation(s)
- T. E. Morozova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - D. A. Shatsky
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N. V. Shikh
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. V. Shikh
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - M. V. Lukina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. A. Kachanova
- Russian Medical Academy of Continuing Professional Education
| | - Z. A. Sozaeva
- Russian Medical Academy of Continuing Professional Education
| | - G. N. Shuev
- Russian Medical Academy of Continuing Professional Education
| | - N. P. Denisenko
- Russian Medical Academy of Continuing Professional Education
| | - E. А. Grishina
- Russian Medical Academy of Continuing Professional Education
| | - D. A. Sychev
- Russian Medical Academy of Continuing Professional Education
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A Narrative Review on Perioperative Pain Management Strategies in Enhanced Recovery Pathways-The Past, Present and Future. J Clin Med 2021; 10:jcm10122568. [PMID: 34200695 PMCID: PMC8229260 DOI: 10.3390/jcm10122568] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 12/14/2022] Open
Abstract
Effective pain management is a key component in the continuum of perioperative care to ensure optimal outcomes for surgical patients. The overutilization of opioids in the past few decades for postoperative pain control has been a major contributor to the current opioid epidemic. Multimodal analgesia (MMA) and enhanced recovery after surgery (ERAS) pathways have been repeatedly shown to significantly improve postoperative outcomes such as pain, function and satisfaction. The current review aims to examine the history of perioperative MMA strategies in ERAS and provide an update with recent evidence. Furthermore, this review details recent advancements in personalized pain medicine. We speculate that the next important step for improving perioperative pain management could be through incorporating these personalized metrics, such as clinical pharmacogenomic testing and patient-reported outcome measurements, into ERAS program.
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Kusic DM, Roberts WN, Jarvis JP, Zhang P, Scheinfeldt LB, Rajula KD, Brenner R, Dempsey MP, Zajic SC. rs11670527 Upstream of ZNF264 Associated with Body Mass Index in the Coriell Personalized Medicine Collaborative. Mil Med 2020; 185:649-655. [PMID: 31498392 DOI: 10.1093/milmed/usz216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION the effects of obesity on health are a concern for the military as they affect the fitness to serve of active service members, increase costs to the Military Health System, and reduce quality of life for veterans and beneficiaries. Although obesity can be influenced by behavioral and environmental factors, it has also been shown to be associated with genetic risk factors that are not fully understood. MATERIALS AND METHODS we performed a genome-wide association study of 5,251 participants in the Coriell Personalized Medicine Collaborative, which includes 2,111 Air Force participants. We applied a generalized linear model, using principal component analysis to account for population structure, and analyzed single-variant associations with body mass index (BMI) as a continuous variable, using a Bonferroni-corrected P-value threshold to account for multiplicity. RESULTS we identified one genome-wide significant locus, rs11670527, upstream of the ZNF264 gene on chromosome 19, associated with BMI. CONCLUSIONS the finding of an association between rs11670527 and BMI adds to the growing body of literature characterizing the complex genetics of obesity. These efforts may eventually inform personalized interventions aimed at achieving and maintaining healthy weight.
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Affiliation(s)
- Dara M Kusic
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
| | - Wendy N Roberts
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
| | - Joseph P Jarvis
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
| | - Pan Zhang
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
| | | | - Kaveri D Rajula
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
| | - Ruth Brenner
- Immunization Healthcare Division, Defense Health Agency, Falls Church, VA 22042
| | - Michael P Dempsey
- Defense Threat Reduction Agency, 8725 John J Kingman Rd., Fort Belvoir, VA 22060 Presented as a poster at the 2018 Military Health System Research Symposium, August 2018, Kissimmee, FL: abstract # MHSRS-18-1288
| | - Stefan C Zajic
- Coriell Institute for Medical Research, 403 Haddon Ave, Camden, NJ 08103
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