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A hybrid implementation-effectiveness randomized trial of CYP2D6-guided postoperative pain management.
Thomas, Cameron D; Parvataneni, Hari K; Gray, Chancellor F; Deen, Justin T; Prieto, Hernan A; Pulido, Luis F; Elsey, Amanda R; Elwood, Erica N; Starostik, Petr; Gong, Yan; Fillingim, Roger B; Johnson, Julie A; Cavallari, Larisa H.
Affiliation
  • Thomas CD; Department of Pharmacotherapy and Translation Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.
  • Parvataneni HK; Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, USA.
  • Gray CF; Department of Orthopaedics and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA.
  • Deen JT; Department of Orthopaedics and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA.
  • Prieto HA; Department of Orthopaedics and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA.
  • Pulido LF; Department of Orthopaedics and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA.
  • Elsey AR; Department of Orthopaedics and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA.
  • Elwood EN; Department of Pharmacotherapy and Translation Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.
  • Starostik P; Department of Pharmacotherapy and Translation Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.
  • Gong Y; Department of Pathology, College of Medicine, University of Florida, Gainesville, FL, USA.
  • Fillingim RB; Department of Pharmacotherapy and Translation Research, College of Pharmacy, University of Florida, Gainesville, FL, USA.
  • Johnson JA; Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, FL, USA.
  • Cavallari LH; Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA.
Genet Med ; 23(4): 621-628, 2021 04.
Article in En | MEDLINE | ID: mdl-33420349
PURPOSE: Cytochrome P450 2D6 (CYP2D6) genotype-guided opioid prescribing is limited. The purpose of this type 2 hybrid implementation-effectiveness trial was to evaluate the feasibility of clinically implementing CYP2D6-guided postsurgical pain management and determine that such an approach did not worsen pain control. METHODS: Adults undergoing total joint arthroplasty were randomized 2:1 to genotype-guided or usual pain management. For participants in the genotype-guided arm with a CYP2D6 poor (PM), intermediate (IM), or ultrarapid (UM) metabolizer phenotype, recommendations were to avoid hydrocodone, tramadol, codeine, and oxycodone. The primary endpoints were feasibility metrics and opioid use; pain intensity was a secondary endpoint. Effectiveness outcomes were collected 2 weeks postsurgery. RESULTS: Of 282 patients approached, 260 (92%) agreed to participate. In the genotype-guided arm, 20% had a high-risk (IM/PM/UM) phenotype, of whom 72% received an alternative opioid versus 0% of usual care participants (p < 0.001). In an exploratory analysis, there was less opioid consumption (200 [104-280] vs. 230 [133-350] morphine milligram equivalents; p = 0.047) and similar pain intensity (2.6 ± 0.8 vs. 2.5 ± 0.7; p = 0.638) in the genotype-guided vs. usual care arm, respectively. CONCLUSION: Implementing CYP2D6 to guide postoperative pain management is feasible and may lead to lower opioid use without compromising pain control.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cytochrome P-450 CYP2D6 / Analgesics, Opioid Type of study: Clinical_trials / Guideline Limits: Adult / Humans Language: En Journal: Genet Med Journal subject: GENETICA MEDICA Year: 2021 Document type: Article Affiliation country: United States Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Cytochrome P-450 CYP2D6 / Analgesics, Opioid Type of study: Clinical_trials / Guideline Limits: Adult / Humans Language: En Journal: Genet Med Journal subject: GENETICA MEDICA Year: 2021 Document type: Article Affiliation country: United States Country of publication: United States