Department of Pediatrics, Division of Clinical Pharmacology and Division of Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
Am J Health Syst Pharm. 2023 Jun 22;80(13):852-859. doi: 10.1093/ajhp/zxad025.
We describe the implementation of CYP2D6-focused pharmacogenetic testing to guide opioid prescribing in a quaternary care, nonprofit pediatric academic medical center.
Children are often prescribed oral opioids after surgeries, for cancer pain, and occasionally for chronic pain. In 2004, Cincinnati Children's Hospital Medical Center implemented pharmacogenetic testing for CYP2D6 metabolism phenotype to inform codeine prescribing. The test and reports were updated to align with changes over time in the testing platform, the interpretation of genotype to phenotype, the electronic health record, and Food and Drug Administration (FDA) guidance. The use of the test increased when a research project required testing and decreased as prescribing of oxycodone increased due to FDA warnings about codeine. Education about the opioid-focused pharmacogenetic test was provided to prescribers (eg, the pain and sickle cell teams) as well as patients and families. Education and electronic health record capability increased provider compliance with genotype-guided postsurgical prescribing of oxycodone, although there was a perceived lack of utility for oxycodone prescribing.
The implementation of pharmacogenetic testing to inform opioid prescribing for children has evolved with accumulating evidence and guidelines, requiring changes in reporting of results and recommendations.
我们描述了在一家四级护理非营利性儿科学术医疗中心实施 CYP2D6 靶向药物遗传学检测以指导阿片类药物处方的情况。
儿童在手术后、癌症疼痛时，偶尔也会因慢性疼痛而被开具口服阿片类药物。2004 年，辛辛那提儿童医院医疗中心实施了 CYP2D6 代谢表型药物遗传学检测，以指导可待因的处方。该检测及其报告随着检测平台、基因型到表型的解读、电子病历和食品药品监督管理局（FDA）指南的变化而不断更新。当一项研究项目需要检测时，该检测的使用会增加，而由于 FDA 对可待因的警告导致羟考酮的处方增加，检测的使用会减少。我们向开处方的医生（如疼痛和镰状细胞团队）以及患者和家属提供了有关阿片类药物相关药物遗传学检测的教育。尽管人们认为羟考酮的处方缺乏实用性，但药物遗传学检测的教育和电子病历功能增加了医生根据基因型指导术后羟考酮处方的遵从性。
随着循证医学证据和指南的不断积累，为儿童提供阿片类药物处方的药物遗传学检测的实施也在不断发展，这需要对检测结果和建议的报告进行更改。
