Royal Marsden Hospital, London, UK.
Curr Opin Support Palliat Care. 2012 Mar;6(1):10-6. doi: 10.1097/SPC.0b013e32834f6a07.
On a population level, there is no difference in terms of efficacy or side-effects between any of the strong opioids. On an individual level, however, there is marked variation in response to opioids. This review presents some of the recent advances in opioid pharmacogenetic studies.
A growing number of genes have been studied in a number of different patient populations. Most data have come from candidate-gene studies. There have been two genome-wide association studies in pain and opioid response. The clinical and genetic complexity of response to opioids has limited the clinical applicability of the genetic results. Currently, interindividual variation in opioid response is managed clinically through a process known as opioid switching. The evidence supporting the efficacy of opioid switching is poor, mainly because randomized controlled trials in this area are lacking.
Adequately powered studies to allow identification of genetic variants with small effect size and exploration of gene-gene interaction are needed. Integration of genetic analysis in clinical studies with carefully defined outcome measures will increase the likelihood of identifying clinical and genetic factors which can be used to predict opioid response.
从人群水平来看，任何一种强效阿片类药物在疗效或副作用方面都没有差异。然而，从个体水平来看，对阿片类药物的反应存在显著差异。本文综述了阿片类药物药物遗传学研究的一些最新进展。
许多不同的患者群体对越来越多的基因进行了研究。大多数数据来自候选基因研究。有两项关于疼痛和阿片类药物反应的全基因组关联研究。阿片类药物反应的临床和遗传复杂性限制了遗传结果的临床适用性。目前，通过一种称为阿片类药物转换的过程来管理个体间阿片类药物反应的差异。支持阿片类药物转换有效性的证据很少，主要是因为该领域缺乏随机对照试验。
需要进行充分的研究，以确定具有较小效应大小的遗传变异，并探索基因-基因相互作用。将遗传分析整合到具有明确定义的结果测量的临床研究中，将增加识别可用于预测阿片类药物反应的临床和遗传因素的可能性。
