Kirsh Kenneth L, Ehlenberger Eric, Huskey Angela, Strickland Jennifer, Egan City Kathleen, Passik Steven D
J Pain Palliat Care Pharmacother. 2014 Mar;28(1):28-32. doi: 10.3109/15360288.2013.878015.
Pharmacogenetic testing (PGT) is part of increasing efforts to personalize medicine, hopefully leading to better medication selection with more effective, less toxic therapies. Pharmacogenetic testing has relevance for chronic pain treatment, given the frequent comorbidities and polypharmacy. This retrospective study explored the prevalence of polymorphisms in a specialty pain practice in Louisiana. Pharmacogenetic testing was conducted for the cytochrome P450 (CYP) enzymes CYP2B6, CYP2C19, and CYP2D6, or the uridine diphosphate-glucuronosyltransferase 2 family polypeptide B15 (UGT2B15) enzyme utilizing a noninvasive, saliva-based test based on clinical decision-making. The sample consisted of 61 men (58.7%) and 41 women (39.4%), with an average age of 46.7 years (range = 23-83, SD = 11.5 years). Across all tests, 164 (42.3%) were extensive, 99 (25.5%) were intermediate, 28 (7.2%) were ultrarapid, and 27 (7%) were poor metabolizers. Only three patients who had been tested were found to be extensive (normal) for all four genes. These data demonstrate that genetic polymorphisms were frequently encountered. Consideration should be given to obtaining PGT as an aspect of evaluation and treatment planning when working with patients in need of specialty pain consultation and care. Caution is needed, as this brief report encompasses results from a single pain practice in one geographic location with a potentially distinct prevalence of genetic polymorphisms. Further prospective study is needed.
药物遗传学检测（PGT）是实现医学个性化不断努力的一部分，有望带来更好的药物选择，采用更有效、毒性更小的治疗方法。鉴于慢性疼痛治疗中常见的合并症和多药联用情况，药物遗传学检测对其治疗具有重要意义。这项回顾性研究探讨了路易斯安那州一家专科疼痛诊所中基因多态性的发生率。基于临床决策，采用一种非侵入性的唾液检测方法，对细胞色素P450（CYP）酶CYP2B6、CYP2C19和CYP2D6，或尿苷二磷酸葡萄糖醛酸转移酶2家族多肽B15（UGT2B15）酶进行药物遗传学检测。样本包括61名男性（58.7%）和41名女性（39.4%），平均年龄为46.7岁（范围 = 23 - 83岁，标准差 = 11.5岁）。在所有检测中，164人（42.3%）为广泛代谢型，99人（25.5%）为中间代谢型，28人（7.2%）为超快代谢型，27人（7%）为慢代谢型。在所有四个基因检测中，只有三名受测患者被发现为广泛（正常）代谢型。这些数据表明基因多态性很常见。在为需要专科疼痛咨询和护理的患者提供评估和治疗计划时，应考虑将药物遗传学检测作为其中一个方面。需要谨慎，因为这份简短报告涵盖的是一个地理位置单一疼痛诊所的结果，基因多态性的发生率可能具有独特性。还需要进一步的前瞻性研究。
