Pharmacogenomic-guided opioid therapy for pain: a systematic review and meta-analysis of randomised controlled trials

Optimising opioid therapy is challenging due to variable patient responses linked to genetic variation. Pharmacogenomic-guided prescribing holds promise for personalisation, but its clinical effectiveness requires evaluation. We performed a systematic review and meta-analysis of RCTs comparing pharmacogenomic-guided versus standard opioid prescribing in adults. Adhering to PRISMA, we assessed risk of bias (RoB 2) and evidence certainty (GRADE). Six RCTs met inclusion criteria from 2496 screened articles. Meta-analysis showed pharmacogenomic-guided prescribing was associated with significantly reduced opioid consumption (SMD -0.38, 95% CI -0.67 to -0.08, p = 0.01). However, no significant difference in pain intensity was observed between groups (SMD -0.31, 95% CI -0.89 to 0.27, p = 0.30). Evidence regarding adverse events was limited to one trial, which reported a statistically significant reduction in incidence in the pharmacogenomic group (median [IQR]: 1 [0-2] vs. 3 [1-5]; p < 0.01). Further research is needed to determine if pharmacogenomics can improve opioid therapy outcomes.