Determining the potential clinical value of panel-based pharmacogenetic testing in patients with chronic pain or gastroesophageal reflux disease

Pharmacogenomics J. 2021 Dec;21(6):657-663. doi: 10.1038/s41397-021-00244-6. Epub 2021 Jun 1.

Abstract

We aimed to determine the potential value of panel-based pharmacogenetic (PGx) testing in patients with chronic pain or gastroesophageal reflux disease (GERD) who underwent single-gene PGx testing to guide opioid or proton pump inhibitor (PPI) therapy, respectively. Of 448 patients included (chronic pain, n = 337; GERD, n = 111), mean age was 57 years, 68% were female, and 73% were white. Excluding opiates for the pain cohort and PPIs for the GERD cohort, 76.6% of patients with pain and 71.2% with GERD were prescribed at least one additional medication with a high level of PGx evidence, most commonly ondansetron or selective serotonin reuptake inhibitors. The most common genes that could inform PGx drug prescribing were CYP2C19, CYP2D6, CYP2C9, and SLCO1B1. Our findings suggest that patients with chronic pain or GERD are commonly prescribed drugs with a high level of evidence for a PGx-guided approach, supporting panel-based testing in these populations.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use*
  • Chronic Pain / diagnosis
  • Chronic Pain / drug therapy*
  • Chronic Pain / genetics
  • Clinical Decision-Making
  • Cytochrome P-450 CYP2C19 / genetics
  • Cytochrome P-450 CYP2C9 / genetics
  • Cytochrome P-450 CYP2D6 / genetics
  • Female
  • Gastroesophageal Reflux / diagnosis
  • Gastroesophageal Reflux / drug therapy*
  • Gastroesophageal Reflux / genetics
  • Humans
  • Liver-Specific Organic Anion Transporter 1 / genetics
  • Male
  • Middle Aged
  • Pharmacogenetics
  • Pharmacogenomic Testing*
  • Pharmacogenomic Variants*
  • Pragmatic Clinical Trials as Topic
  • Precision Medicine*
  • Predictive Value of Tests
  • Proton Pump Inhibitors / adverse effects
  • Proton Pump Inhibitors / therapeutic use*

Substances

  • Analgesics, Opioid
  • Liver-Specific Organic Anion Transporter 1
  • Proton Pump Inhibitors
  • SLCO1B1 protein, human
  • CYP2C9 protein, human
  • Cytochrome P-450 CYP2C9
  • CYP2C19 protein, human
  • Cytochrome P-450 CYP2C19
  • Cytochrome P-450 CYP2D6