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Papers of the Week

Papers: 15 Jul 2023 - 21 Jul 2023


Genetics, Human Studies, Molecular/Cellular, Neurobiology, Pharmacology/Drug Development


2023 Jun 28

Int J Mol Sci




Pharmacogenetic Guided Opioid Therapy Improves Chronic Pain Outcomes and Comorbid Mental Health: A Randomized, Double-Blind, Controlled Study.


Agulló L, Aguado I, Muriel J, Margarit C, Gómez A, Escorial M, Sánchez A, Fernández A, Peiró AM


Interindividual variability in analgesic response is at least partly due to well-characterized polymorphisms that are associated with opioid dosing and adverse outcomes. The Clinical Pharmacogenetics Implementation Consortium (CPIC) has put forward recommendations for the phenotype, but the list of studied drug-gene pairs continues to grow. This clinical trial randomized chronic pain patients ( = 60), referred from primary care to pain unit care into two opioid prescribing arms, one guided by , μ-opioid receptor (), and catechol-O-methyl transferase () genotypes vs. one with clinical routine. The genotype-guided treatment reduced pain intensity (76 vs. 59 mm, < 0.01) by improving pain relief (28 vs. 48 mm, < 0.05), increased quality of life (43 vs. 56 mm < 0.001), and lowered the incidence of clinically relevant adverse events (3 [1-5] vs. 1 [0-2], < 0.01) and 42% opioid dose (35 [22-61] vs. 60 [40-80] mg/day, < 0.05) as opposed to usual prescribing arm. The final health utility score was significantly higher (0.71 [0.58-0.82] vs. 0.51 [0.13-0.67] controls, < 0.05) by improving sleepiness and depression comorbidity, with a significant reduction of 30-34% for headache, dry mouth, nervousness, and constipation. A large-scale implementation analysis could help clinical translation, together with a pharmaco-economic evaluation.