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Pharmacogenetic Testing for Analgesic Adverse Effects: Pediatric Case Series
Renee C B Manworren1, Lauren Jeffries, Ashley Pantaleao
1*Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, CT †Department of Pediatrics, University of Connecticut School of Medicine, Farmington §Genetics Research Center, Hartford Hospital, Hartford ‡Center for the Advancement in Managing Pain, University of Connecticut School of Nursing Storrs ∥Genetics Research Center, Hartford Hospital, Genomas Laboratory of Personalized Health Inc, Hartford, CT.
Pharmacogenetic testing identified genetic variants in CYP2D6, CYP2C19, and CYP2C9 in most pediatric pain patients, impacting analgesic efficacy and safety. This highlights the need for integrating genetic insights into pain management strategies.
Area of Science:
- Pharmacogenomics
- Clinical Pharmacology
- Pediatric Pain Management
Background:
- Genetic variations in drug-metabolizing enzymes, such as CYP2D6, CYP2C19, and CYP2C9, can significantly influence analgesic effectiveness and safety.
- Altered drug metabolism due to these genetic variants can lead to treatment failure or adverse drug reactions in patients experiencing pain.
Purpose of the Study:
- To retrospectively analyze clinical data of pediatric patients undergoing pharmacogenetic testing for CYP2D6, CYP2C19, and CYP2C9 gene variants.
- To correlate identified genetic variants and Metabolic Reserve (MR) index with analgesic efficacy and adverse effects in a pediatric pain management setting.
Main Methods:
- Retrospective review of medical records for 19 pediatric patients referred for pharmacogenetic testing between 2010 and 2013.
- Genotyping was performed to determine functional status of CYP2D6, CYP2C19, and CYP2C9 genes; Metabolic Reserve (MR) index was calculated.
- Phenotypic analgesic response was characterized by extracting data on efficacy and adverse effects from inpatient and outpatient records.
Main Results:
- CYP2D6 genetic variants were found in 84% (16/19) of patients, including ultra-rapid, deficient, poor, and null metabolizers.
- Two of three patients with functional CYP2D6 status were also CYP2C19 null metabolizers.
- Metabolic Reserve (MR) scores exhibited a bimodal distribution, with peaks at 4.0/4.5 and 7.0, ranging from 3.0 to 7.0.
Conclusions:
- Clinical assessment of analgesic ineffectiveness and adverse effects strongly predicts the presence of CYP2D6, CYP2C19, and CYP2C9 alleles affecting drug metabolism.
- Further research is warranted to integrate pharmacogenetic data into clinical practice for improved analgesic prescribing and anticipatory guidance in pediatric pain management.
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