Original scientific paper

https://doi.org/10.2478/acph-2023-0018

Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences

AVIER MURIEL ; Neuropharmacology applied to Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL), c/ Pintor Baeza, 12, 03010, Alicante, Spain
MÓNICA ESCORIAL ; Neuropharmacology applied to Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL), c/ Pintor Baeza, 12, 03010, Alicante, Spain; Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
CÉSAR MARGARIT ; Neuropharmacology applied to Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL), c/ Pintor Baeza, 12, 03010, Alicante, Spain; Pain Unit, Dr. Balmis General University Hospital, ISABIAL, c/ Pintor Baeza, 12, 03010, Alicante, Spain
JORDI BARRACHINA ; Neuropharmacology applied to Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL), c/ Pintor Baeza, 12, 03010, Alicante, Spain; Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
CRISTIAN CARVAJAL ; Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
DOMINGO MORALES ; Operations Research Centre, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
ANA PEIRÓ ; Neuropharmacology applied to Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL), c/ Pintor Baeza, 12, 03010, Alicante, Spain; Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain; Pain Unit, Dr. Balmis General University Hospital, ISABIAL, c/ Pintor Baeza, 12, 03010, Alicante, Spain; Clinical Pharmacology Department, Dr. Balmis General University Hospital, ISABIAL, c/ Pintor Baeza, 12, 03010 Alicante, Spain

Abstract

1 Neuropharmacology applied to Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL), c/ Pintor Baeza, 12, 03010, Alicante, Spain
2 Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
3 Pain Unit, Dr. Balmis General University Hospital, ISABIAL, c/ Pintor Baeza, 12, 03010, Alicante, Spain
4 Operations Research Centre, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
5 Clinical Pharmacology Department, Dr. Balmis General University Hospital, ISABIAL
c/ Pintor Baeza, 12, 03010 Alicante, Spain

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.

Keywords

chronic pain; drug deprescription; opioid use disorder; long-term monitoring; pharmacogenetics; sex differences

Hrčak ID:

286225

URI

https://hrcak.srce.hr/286225

Publication date:

30.6.2023.

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