Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences
More than half of patients with opioid use disorder for chronic non-cancer pain (CNCP) reduced their dose through a progressive opioid withdrawal supported by a rotation to buprenorphine and/or tramadol. The aim of this research is to analyse the long-term effectiveness of opioid deprescription taki...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Sciendo
2023-06-01
|
| Series: | Acta Pharmaceutica |
| Subjects: | |
| Online Access: | https://doi.org/10.2478/acph-2023-0018 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832545205384904704 |
|---|---|
| author | Muriel Javier Escorial Mónica Margarit César Barrachina Jordi Carvajal Cristian Morales Domingo Peiró Ana M. |
| author_facet | Muriel Javier Escorial Mónica Margarit César Barrachina Jordi Carvajal Cristian Morales Domingo Peiró Ana M. |
| author_sort | Muriel Javier |
| collection | DOAJ |
| description | More than half of patients with opioid use disorder for chronic non-cancer pain (CNCP) reduced their dose through a progressive opioid withdrawal supported by a rotation to buprenorphine and/or tramadol. The aim of this research is to analyse the long-term effectiveness of opioid deprescription taking into account the impact of sex and pharmacogenetics on the inter-individual variability. A cross-sectional study was carried out from October 2019 to June 2020 on CNCP patients who had previously undergone an opioid deprescription (n = 119 patients). Demographic, clinical (pain, relief and adverse events) and therapeutic (analgesic use) outcomes were collected. Effectiveness (< 50 mg per day of morphine equivalent daily dose without any aberrant opioid use behaviour) and safety (number of side-effects) were analysed in relation to sex differences and pharmacogenetic markers impact [OPRM1 genotype (rs1799971) and CYP2D6 phenotypes]. Long-term opioid deprescription was achieved in 49 % of the patients with an increase in pain relief and a reduction of adverse events. CYP2D6 poor metabolizers showed the lowest long-term opioid doses. Here, women showed a higher degree of opioid deprescription, but increased use of tramadol and neuromodulators, as well as an increased number of adverse events. Long-term deprescription was successful in half of the cases. Understanding sex and gender interaction plus a genetic impact could help to design more individualized strategies for opioid deprescription. |
| format | Article |
| id | doaj-art-ed5d0f056c014a5b95621f8fb4acd9cf |
| institution | Kabale University |
| issn | 1846-9558 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | Sciendo |
| record_format | Article |
| series | Acta Pharmaceutica |
| spelling | doaj-art-ed5d0f056c014a5b95621f8fb4acd9cf2025-02-03T08:17:11ZengSciendoActa Pharmaceutica1846-95582023-06-0173222724110.2478/acph-2023-0018Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differencesMuriel Javier0Escorial Mónica1Margarit César2Barrachina Jordi3Carvajal Cristian4Morales Domingo5Peiró Ana M.61Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain2Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain4Operations Research Centre, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, SpainMore than half of patients with opioid use disorder for chronic non-cancer pain (CNCP) reduced their dose through a progressive opioid withdrawal supported by a rotation to buprenorphine and/or tramadol. The aim of this research is to analyse the long-term effectiveness of opioid deprescription taking into account the impact of sex and pharmacogenetics on the inter-individual variability. A cross-sectional study was carried out from October 2019 to June 2020 on CNCP patients who had previously undergone an opioid deprescription (n = 119 patients). Demographic, clinical (pain, relief and adverse events) and therapeutic (analgesic use) outcomes were collected. Effectiveness (< 50 mg per day of morphine equivalent daily dose without any aberrant opioid use behaviour) and safety (number of side-effects) were analysed in relation to sex differences and pharmacogenetic markers impact [OPRM1 genotype (rs1799971) and CYP2D6 phenotypes]. Long-term opioid deprescription was achieved in 49 % of the patients with an increase in pain relief and a reduction of adverse events. CYP2D6 poor metabolizers showed the lowest long-term opioid doses. Here, women showed a higher degree of opioid deprescription, but increased use of tramadol and neuromodulators, as well as an increased number of adverse events. Long-term deprescription was successful in half of the cases. Understanding sex and gender interaction plus a genetic impact could help to design more individualized strategies for opioid deprescription.https://doi.org/10.2478/acph-2023-0018chronic paindrug deprescriptionopioid use disorderlong-term monitoringpharmacogeneticssex differences |
| spellingShingle | Muriel Javier Escorial Mónica Margarit César Barrachina Jordi Carvajal Cristian Morales Domingo Peiró Ana M. Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences Acta Pharmaceutica chronic pain drug deprescription opioid use disorder long-term monitoring pharmacogenetics sex differences |
| title | Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences |
| title_full | Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences |
| title_fullStr | Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences |
| title_full_unstemmed | Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences |
| title_short | Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences |
| title_sort | long term deprescription in chronic pain and opioid use disorder patients pharmacogenetic and sex differences |
| topic | chronic pain drug deprescription opioid use disorder long-term monitoring pharmacogenetics sex differences |
| url | https://doi.org/10.2478/acph-2023-0018 |
| work_keys_str_mv | AT murieljavier longtermdeprescriptioninchronicpainandopioidusedisorderpatientspharmacogeneticandsexdifferences AT escorialmonica longtermdeprescriptioninchronicpainandopioidusedisorderpatientspharmacogeneticandsexdifferences AT margaritcesar longtermdeprescriptioninchronicpainandopioidusedisorderpatientspharmacogeneticandsexdifferences AT barrachinajordi longtermdeprescriptioninchronicpainandopioidusedisorderpatientspharmacogeneticandsexdifferences AT carvajalcristian longtermdeprescriptioninchronicpainandopioidusedisorderpatientspharmacogeneticandsexdifferences AT moralesdomingo longtermdeprescriptioninchronicpainandopioidusedisorderpatientspharmacogeneticandsexdifferences AT peiroanam longtermdeprescriptioninchronicpainandopioidusedisorderpatientspharmacogeneticandsexdifferences |