Jethwa S, Ball M, Langlands K
University of Cambridge, Cambridge, UK.
Frimley Health NHS Foundation Trust, Camberley, UK.
Pharmacogenomics J. 2025 Jul 12;25(4):20. doi: 10.1038/s41397-025-00379-w.
Optimising opioid therapy is challenging due to variable patient responses linked to genetic variation. Pharmacogenomic-guided prescribing holds promise for personalisation, but its clinical effectiveness requires evaluation. We performed a systematic review and meta-analysis of RCTs comparing pharmacogenomic-guided versus standard opioid prescribing in adults. Adhering to PRISMA, we assessed risk of bias (RoB 2) and evidence certainty (GRADE). Six RCTs met inclusion criteria from 2496 screened articles. Meta-analysis showed pharmacogenomic-guided prescribing was associated with significantly reduced opioid consumption (SMD -0.38, 95% CI -0.67 to -0.08, p = 0.01). However, no significant difference in pain intensity was observed between groups (SMD -0.31, 95% CI -0.89 to 0.27, p = 0.30). Evidence regarding adverse events was limited to one trial, which reported a statistically significant reduction in incidence in the pharmacogenomic group (median [IQR]: 1 [0-2] vs. 3 [1-5]; p < 0.01). Further research is needed to determine if pharmacogenomics can improve opioid therapy outcomes.
由于与基因变异相关的患者反应存在差异，优化阿片类药物治疗具有挑战性。药物基因组学指导的处方有望实现个性化，但需要评估其临床有效性。我们对比较药物基因组学指导与成人标准阿片类药物处方的随机对照试验进行了系统评价和荟萃分析。遵循PRISMA，我们评估了偏倚风险（RoB 2）和证据确定性（GRADE）。在筛选的2496篇文章中，有6项随机对照试验符合纳入标准。荟萃分析表明，药物基因组学指导的处方与阿片类药物消耗量显著降低相关（标准化均数差-0.38，95%可信区间-0.67至-0.08，p = 0.01）。然而，两组之间在疼痛强度方面未观察到显著差异（标准化均数差-0.31，95%可信区间-0.89至0.27，p = 0.30）。关于不良事件的证据仅限于一项试验，该试验报告药物基因组学组的发生率有统计学显著降低（中位数[四分位数间距]：1[0-2]对3[1-5]；p < 0.01）。需要进一步研究以确定药物基因组学是否能改善阿片类药物治疗效果。
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