Michaud Veronique, Bikmetov Ravil, Smith Matt K, Dow Pamela, Darakjian Lucy I, Deodhar Malavika, Cicali Brian, Bain Kevin T, Turgeon Jacques
Tabula Rasa HealthCare (TRHC), Precision Pharmacotherapy Research and Development Institute, Orlando, FL 32827, USA.
Faculty de Pharmacie, Université de Montréal, Montréal, QC H3T 1J4, Canada.
J Pers Med. 2021 Nov 10;11(11):1174. doi: 10.3390/jpm11111174.
Cytochrome P450 2D6 (CYP2D6) activity is highly variable due to several factors, including genetic polymorphisms and drug-drug-gene interactions. Hydrocodone, oxycodone, codeine, and tramadol the most commonly prescribed CYP2D6-activated opioids for pain. However, the co-administration of CYP2D6 interacting drugs can modulate CYP2D6-medicated activation of these opioids, affecting drug analgesia, effectiveness, and safety, and can impact healthcare costs. A retrospective, observational cohort analysis was performed in a large ( = 50,843) adult population. This study used drug claims data to derive medication risk scores and matching propensity scores to estimate the effects of opioid use and drug-drug interactions (DDIs) on medical expenditures. 4088 individuals were identified as opioid users; 95% of those were prescribed CYP2D6-activated opioids. Among those, 15% were identified as being at risk for DDIs. Opioid users had a significant increase in yearly medical expenditure compared to non-opioid users ($2457 vs. $1210). In matched individuals, average healthcare expenditures were higher for opioid users with DDIs compared to those without DDIs ($7841 vs. $5625). The derived medication risk score was higher in CYP2D6 opioid users with interacting drug(s) compared to no DDI (15 vs. 12). Higher costs associated with CYP2D6 opioid use under DDI conditions suggest inadequate CYP2D6 opioid prescribing practices. Efforts to improve chronic opioid use in adults should reduce interacting drug combinations, especially among patients using CYP2D6 activated opioids.
细胞色素P450 2D6（CYP2D6）的活性因多种因素而高度可变，包括基因多态性和药物-药物-基因相互作用。氢可酮、羟考酮、可待因和曲马多是最常用于疼痛治疗的经CYP2D6激活的阿片类药物。然而，CYP2D6相互作用药物的联合使用可调节这些阿片类药物的CYP2D6介导的激活，影响药物镇痛效果、有效性和安全性，并可能影响医疗成本。在一个大型（n = 50843）成年人群中进行了一项回顾性观察队列分析。本研究使用药物报销数据得出用药风险评分和匹配的倾向评分，以评估阿片类药物使用和药物-药物相互作用（DDIs）对医疗支出的影响。4088人被确定为阿片类药物使用者；其中95%被开具了经CYP2D6激活的阿片类药物。在这些人中，15%被确定存在DDIs风险。与非阿片类药物使用者相比，阿片类药物使用者的年度医疗支出显著增加（2457美元对1210美元）。在匹配个体中，有DDIs的阿片类药物使用者的平均医疗支出高于无DDIs的使用者（7841美元对5625美元）。与无DDIs的CYP2D6阿片类药物使用者相比，有相互作用药物的CYP2D6阿片类药物使用者得出的用药风险评分更高（15对12）。DDI情况下与CYP2D6阿片类药物使用相关的较高成本表明CYP2D6阿片类药物的处方做法存在不足。改善成人慢性阿片类药物使用的措施应减少相互作用的药物组合，尤其是在使用经CYP2D6激活的阿片类药物的患者中。
