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Using pharmacogenomics as an effective tool in minimizing drug related side effects in patients with Chronic regional pain syndrome: A feasibility study
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Using pharmacogenomics as an effective tool in minimizing drug related side effects in patients with Chronic regional pain syndrome: A feasibility study

S. Jain, A. Danesh, M. Laroche, S. Bakhtiari, C. Maxwell, Y. Al-Khalili and R. Cruciani
The journal of pain, v 18(4), pp S58-S59
Apr 2017
DOI: https://doi.org/10.1016/j.jpain.2017.02.228
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.1016/j.jpain.2017.02.228View
Published, Version of Record (VoR) Open Maybe Open Access (Publisher Bronze)

Abstract

Complex Regional Pain Syndrome (CRPS) is a chronic painful condition often treated with polypharmacy placing patients at risk for severe side effects that are often the result of drug- drug interactions (DDI) and drug- gene interactions (DGI). The cytochrome P450 enzyme system is a major metabolic pathway for analgesics. Understanding the substrates, inhibitors and inducers of CYP450 enzyme system for each individual patient could be valuable in predicting these interactions that could result in adverse events. Genetic testing was done for the most common Cytochrome P450 isoenzymes involved in the metabolism of commonly prescribed analgesics in 76 patients diagnosed with CRPS; patients were classified based on their isoenzymatic activity. They were analyzed for 4 cytochrome P450 alleles; CYP2D6, CYP2C9, CYP2C19 and CYP3A5. They were categorized into extensive, intermediate, ultra rapid and poor metabolizers. 24% (n=18) patients were extensive, 62% (n=46) intermediate, 11%(n=8) ultra rapid and 3%(n=2) were poor metabolizers for CYP2D6 allele, which is responsible for 60-70% of cytochrome P450 activity. These results and a list of the medications that the patient was taking was compared against a standardized referral database resulting in a computer-generated report listing DDI and DGI. Of the 76 patients enrolled, 69% had risk for DDI and 92% were at risk for DGI. The severity of the interactions was categorized into critical, moderately severe and safe interactions. 75% of the patients were at risk for critical, 21% for moderately severe and 4% at no risk for DGI/DDI. Overall, 69% and 92% of patients with CRPS were found to be at risk for DDI and DGI respectively. The analysis of potential DDI and DGI may have resulted in reduced medication induced side effects. This preliminary study warrants a randomized controlled trial to establish the clinical significance of gene testing in an outpatient clinical practice.

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Web of Science research areas
Clinical Neurology
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