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CYP2D6指导的阿片类药物管理和术后疼痛控制:一项随机临床试验

Larisa H Cavallari1,2, Rachel A Myers3, Hrishikesh Chakraborty4

  • 1Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville.

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对CYP2D6代谢的遗传测试指导了阿片类药物处方,但在低或中等代谢者中没有改善术后疼痛控制. 这项研究表明,通过CYP2D6引导的疗法对手术疼痛的管理没有好处,目前的多式疗法方法.

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科学领域:

  • 药物基因组学 药物基因组学
  • 疼痛管理 疼痛管理
  • 临床试验 临床试验

背景情况:

  • 细胞染色体P450 2D6 (CYP2D6) 的遗传变异会影响代因素,特拉马多尔和的代谢.
  • 较差或中间CYP2D6代谢剂减少了转化为活性阿片类代谢产物,增加了足够的缓解疼痛的风险.
  • 基于CYP2D6基因型的个性化处方可以优化术后疼痛管理.

研究的目的:

  • 评估CYP2D6引导的阿片类药物处方对术后疼痛和阿片类药物消费的影响.
  • 为了比较接受CYP2D6指导护理的患者和接受标准疼痛管理的患者之间的疼痛控制和阿片类药物的使用.

主要方法:

  • 一个开放的,随机的临床试验,涉及1602名接受手术的参与者.
  • 具有较差或中等CYP2D6代谢器表型的参与者 (n=351) 被随机分配到CYP2D6指导的处方或常规护理.
  • 主要结局是10天的Silverman综合止痛评估 (SIA) 评分,测量疼痛和阿片类药物使用.

主要成果:

  • 在CYP2D6指导的手臂中,处方阿片类药物与CYP2D6表型之间的一致性更高 (64%对27%).
  • 在 CYP2D6 指导和对照组 (2.8; 95% CI, -18.3 到 23.8; P=.80) 之间,在初级结局 (SIA 分数) 中没有发现显著差异.
  • 二次结果,包括疼痛强度等级和整体阿片类药物使用 (MME/d),也没有在两组之间有所差异.

结论:

  • 尽管对 CYP2D6 低和中间代谢器的处方模式发生了显著的变化,但CYP2D6 指导的阿片类药物治疗没有改善术后疼痛控制.
  • 这些发现不支持在当代多模式疼痛管理策略的背景下使用CYP2D6引导的阿片类药物治疗.
  • 可能需要进一步的研究来探索替代的药物基因组方法或为特定患者群体改进策略.