Implementation of CYP2D6-guided opioid therapy at Cincinnati Children's Hospital Medical Center.
Implementation of CYP2D6-guided opioid therapy at Cincinnati Children's Hospital Medical Center.
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辛辛那提儿童医院医疗中心实施 CYP2D6 引导的阿片类药物治疗。
DOI：
10.1093/ajhp/zxad025
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Glauser,TracyA
中科院分区：
文献类型：
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作者：
Ramsey,LauraB;Prows,CynthiaA;Chidambaran,Vidya;Sadhasivam,Senthilkumar;Quinn,CharlesT;Teusink-Cross,Ashley;TangGirdwood,Sonya;Dawson,DBrian;Vinks,AlexanderA;Glauser,TracyA
目的：介绍在一家非营利性儿科学术医疗中心实施以cyp2d6为重点的药物遗传学检测来指导阿片类药物处方。儿童经常在手术后服用口服阿片类药物，用于治疗癌症疼痛，偶尔也用于治疗慢性疼痛。2004年，辛辛那提儿童医院医学中心实施了CYP2D6代谢表型的药物遗传学检测，为可待因处方提供信息。测试和报告进行了更新，以配合测试平台、基因型到表型的解释、电子健康记录和食品和药物管理局（FDA）指南的变化。当一个研究项目需要测试时，该测试的使用增加，而由于FDA对可待因的警告，羟考酮的处方增加，该测试的使用减少。向开处方者（如疼痛和镰状细胞小组）以及患者和家属提供了以阿片类药物为重点的药物遗传学测试的教育。教育和电子健康记录能力增加了医生对基因型指导的术后羟考酮处方的依从性，尽管人们认为羟考酮处方缺乏实用性。结论：随着证据和指南的积累，为儿童阿片类药物处方提供药物遗传学检测的实施不断发展，需要改变结果报告和建议。
PurposeWe describe the implementation of CYP2D6-focused pharmacogenetic testing to guide opioid prescribing in a quaternary care, nonprofit pediatric academic medical center.SummaryChildren 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.ConclusionThe 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.