药物基因组学在慢性疼痛治疗中的应用：从疾病到治疗以及对临床实践的挑战。

Pharmacogenomics in chronic pain therapy: from disease to treatment and challenges for clinical practice.

机构信息

São Paulo State University, UNESP - School of Pharmaceutical Sciences, Araraquara, SP, Brazil.

São Paulo University, USP - School of Pharmaceutical Sciences of Ribeirão Preto, Ribeirão Preto, SP, Brazil.

出版信息

Pharmacogenomics. 2019 Aug;20(13):971-982. doi: 10.2217/pgs-2019-0066.

DOI:10.2217/pgs-2019-0066

PMID:31486733

Abstract

Pharmacogenomics (PGx) has emerged as an encouraging tool in chronic pain therapy. Genetic variations associated with drug effectiveness or adverse reactions (amitriptyline/nortriptyline/codeine/oxycodone/tramadol-CYP2D6, amitriptyline-CYP2C19, carbamazepine-HLA-A, carbamazepine/oxcarbazepine-HLA-B) can be used to guide chronic pain management. Despite this evidence, many obstacles still need to be overcome for the effective clinical implementation of PGx. To translate the pharmacogenetic testing into actionable clinical decisions, the Clinical Pharmacogenetics Implementation Consortium has been developing guidelines for several drug-gene pairs. This review will show the applicability of PGx in chronic pain from disease to treatment; report the drug-gene pairs with strongest evidences in the clinic; and the challenges for the clinical implementation of PGx.

摘要

药物基因组学（PGx）已成为慢性疼痛治疗中令人鼓舞的工具。与药物疗效或不良反应相关的遗传变异（阿米替林/去甲替林/可待因/羟考酮/曲马多-CYP2D6、阿米替林-CYP2C19、卡马西平-HLA-A、卡马西平/奥卡西平-HLA-B）可用于指导慢性疼痛管理。尽管有这些证据，但要将药物基因组学检测有效地应用于临床，仍有许多障碍需要克服。为了将药物遗传学检测转化为可行的临床决策，临床药物基因组学实施联盟一直在为若干药物-基因对制定指南。这篇综述将展示 PGx 在慢性疼痛从疾病到治疗中的适用性；报告在临床中具有最强证据的药物-基因对；以及 PGx 临床实施的挑战。