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Escorial M, Muriel J, Agulló L, Zandonai T, Margarit C, Morales D, Peiró AM. Clinical prediction of opioid use disorder in chronic pain patients: a cohort-retrospective study with a pharmacogenetic approach. Minerva Anestesiol 2024:S0375-9393.24.17864-9. [PMID: 38619184 DOI: 10.23736/s0375-9393.24.17864-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Opioids are widely used in chronic non-cancer pain (CNCP) management. However, they remain controversial due to serious risk of causing opioid use disorder (OUD). Our main aim was to develop a predictive model for future clinical translation that include pharmacogenetic markers. METHODS An observational study was conducted in 806 pre-screened Spanish CNCP patients, under long-term use of opioids, to compare cases (with OUD, N.=137) with controls (without OUD, N.=669). Mu-opioid receptor 1 (OPRM1, A118G, rs1799971) and catechol-O-methyltransferase (COMT, G472A, rs4680) genetic variants plus cytochrome P450 2D6 (CYP2D6) liver enzyme phenotypes were analyzed. Socio-demographic, clinical and pharmacological outcomes were also registered. A logistic regression model was performed. The model performance and diagnostic accuracy were calculated. RESULTS OPRM1-AA genotype and CYP2D6 poor and ultrarapid metabolizers together with three other potential predictors: 1) age; 2) work disability; 3) oral morphine equivalent daily dose (MEDD), were selected with a satisfactory diagnostic accuracy (sensitivity: 0.82 and specificity: 0.85), goodness of fit (P=0.87) and discrimination (0.89). Cases were ten-year younger with lower incomes, more sleep disturbances, benzodiazepines use, and history of substance use disorder in front of controls. CONCLUSIONS Functional polymorphisms related to OPRM1 variant and CYP2D6 phenotypes may predict a higher OUD risk. Established risk factors such as young age, elevated MEDD and lower incomes were identified. A predictive model is expected to be implemented in clinical setting among CNCP patients under long-term opioids use.
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Affiliation(s)
- Mónica Escorial
- Unit of Pharmacogenetics, Department of Clinical Pharmacology, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Institute of Bioengineering, Miguel Hernández University, Elche, Spain
| | - Javier Muriel
- Unit of Pharmacogenetics, Department of Clinical Pharmacology, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Laura Agulló
- Unit of Pharmacogenetics, Department of Clinical Pharmacology, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Institute of Bioengineering, Miguel Hernández University, Elche, Spain
| | - Thomas Zandonai
- Unit of Pharmacogenetics, Department of Clinical Pharmacology, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Addiction Science Lab, Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - César Margarit
- Pain Unit, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Domingo Morales
- Operations Research Center, Miguel Hernández University, Elche, Spain
| | - Ana M Peiró
- Unit of Pharmacogenetics, Department of Clinical Pharmacology, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain -
- Institute of Bioengineering, Miguel Hernández University, Elche, Spain
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Agulló L, Segura A, Ortuño-Miquel S, Brinca AT, Micol-Ponce R, Arrarte V, Ponce MR, Miró-Martínez P, Zandonai T, Peiró AM. Circulating miRNA-21 is an innovative biomarker for cardiovascular events in erectile dysfunction patients. Front Cardiovasc Med 2024; 11:1301925. [PMID: 38576420 PMCID: PMC10991794 DOI: 10.3389/fcvm.2024.1301925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction It is well-known that circulating microRNAs (miRNAs) play a relevant role in many kinds of diseases by regulating the expression of genes involved in various pathophysiologic processes, including erectile dysfunction (ED) and cardiovascular diseases (CVD). Purpose This study aimed to identify the miRNA-21 profile in the blood samples of patients with ED, CVD, and the combination of both pathologies to elucidate the potential function of miRNA-21. Methods A total of 45 patients with CVD and/or who underwent the erectile function test were included and divided into the following categories: CVD with ED (cases, n = 29) and controls (n = 16) with either ED or CVD. Real-time polymerase chain reaction analysis verified the results. miRNA-21 expression was quantified, and informatics analysis was applied to predict the functions of this differentially expressed miRNA-21. Results A total of 64% of cases (63 ± 9 years, 66% with severe ED, 56% with CV ejection fraction) first presented ED as the sentinel clinical manifestation. Serum miRNA-21 levels in the control ED were significant, up to 10-fold higher than in the CVD controls and cases. A significant inverse (p = 0.0368, β = -2.046) correlation was found between erectile function and miRNA-21 levels. Conclusions Our study provides comprehensive insights into the functional interaction between miRNA-21 and ED in CVD patients. Its relevance lies in the potential of miRNA as a biomarker to be applied in the cardiovascular predictive medicine field.
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Affiliation(s)
- Laura Agulló
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Alicante, Spain
- Institute of Bioengineering, Miguel Hernández University, Elche, Spain
| | - Ana Segura
- Andrology Unit, Urology Department, Dr. Balmis General University Hospital, Alicante, Spain
| | - Samanta Ortuño-Miquel
- Bioinformatics Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Alicante, Spain
| | - Ana Teresa Brinca
- Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Rosa Micol-Ponce
- Institute of Bioengineering, Miguel Hernández University, Elche, Spain
| | - Vicente Arrarte
- Cardiology Department, Dr. Balmis General University Hospital, Alicante, Spain
| | - María Rosa Ponce
- Institute of Bioengineering, Miguel Hernández University, Elche, Spain
| | - Pau Miró-Martínez
- Department of Statistics and Operational Research of the Alcoy Campus of Universitat Politècnica de València, Alicante, Spain
| | - Thomas Zandonai
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Alicante, Spain
- Addiction Science Lab, Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Ana M. Peiró
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Alicante, Spain
- Institute of Bioengineering, Miguel Hernández University, Elche, Spain
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de Miguel L, Ballester P, Egoavil C, Sánchez-Ocaña ML, García-Muñoz AM, Cerdá B, Zafrilla P, Ramos E, Peiró AM. Pharmacogenetics May Prevent Psychotropic Adverse Events in Autism Spectrum Disorder: An Observational Pilot Study. Pharmaceuticals (Basel) 2023; 16:1496. [PMID: 37895967 PMCID: PMC10610471 DOI: 10.3390/ph16101496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Up to 73% of individuals with autism spectrum disorder (ASD) and intellectual disability (ID) currently have prescriptions for psychotropic drugs. This is explained by a higher prevalence of medical and psychiatric chronic comorbidities, which favors polypharmacy, increasing the probability of the appearance of adverse events (AEs). These could be a preventable cause of harm to patients with ASD and an unnecessary waste of healthcare resources. OBJECTIVE To study the impact of pharmacogenetic markers on the prevention of AE appearance in a population with ASD and ID. METHODS This is a cross-sectional, observational study (n = 118, 72 participants completed all information) in the ASD population. Sociodemographic and pharmacological data were gathered. The Udvalg for Kliniske Undersøgelser Scale (UKU Scale) was used to identify AEs related to the use of psychotropic medication. Polymorphisms of DOP2, ABCB1, and COMT were genotyped and correlated with the AE to find candidate genes. Furthermore, a review of all medications assessed in a clinical trial for adults with autism was performed to enrich the search for potential pharmacogenetic markers, keeping in mind the usual medications. RESULTS The majority of the study population were men (75%) with multiple comorbidities and polypharmacy, the most frequently prescribed drugs were antipsychotics (69%); 21% of the participants had four or more AEs related to psychotropic drugs. The most common were "Neurological" and" Psychiatric" (both 41%). Statistical analysis results suggested a significant correlation between the neurological symptoms and the DOP2 genotype, given that they are not equally distributed among its allelic variants. The final review considered 19 manuscripts of medications for adults with ASD, and the confirmed genetic markers for those medications were consulted in databases. CONCLUSION A possible correlation between neurologic AEs and polymorphisms of DOP2 was observed; therefore, studying this gene could contribute to the safety of this population's prescriptions. The following studies are underway to maximize statistical power and have a better representation of the population.
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Affiliation(s)
- Laura de Miguel
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital of Alicante, c/Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202 Elche, Spain
| | - Pura Ballester
- Faculty of Pharmacy and Nutrition, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Guadalupe, 30107 Murcia, Spain
| | - Cecilia Egoavil
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital of Alicante, c/Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Pharmacology Unit, Dr. Balmis General University Hospital, 03010 Alicante, Spain
| | - María Luisa Sánchez-Ocaña
- Faculty of Pharmacy and Nutrition, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Guadalupe, 30107 Murcia, Spain
| | - Ana María García-Muñoz
- Faculty of Pharmacy and Nutrition, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Guadalupe, 30107 Murcia, Spain
| | - Begoña Cerdá
- Faculty of Pharmacy and Nutrition, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Guadalupe, 30107 Murcia, Spain
| | - Pilar Zafrilla
- Faculty of Pharmacy and Nutrition, Campus de los Jerónimos, Universidad Católica San Antonio de Murcia (UCAM), Guadalupe, 30107 Murcia, Spain
| | - Enrique Ramos
- Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202 Elche, Spain
| | - Ana M. Peiró
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital of Alicante, c/Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202 Elche, Spain
- Clinical Pharmacology Unit, Dr. Balmis General University Hospital, 03010 Alicante, Spain
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Ballester P, Espadas C, Almenara S, Barrachina J, Muriel J, Ramos E, Toral N, Belda C, Peiró AM. CYP2D6 Genotype and Pharmacovigilance Impact on Autism Spectrum Disorder: A Naturalistic Study with Extreme Phenotype Analysis. Pharmaceuticals (Basel) 2023; 16:954. [PMID: 37513866 PMCID: PMC10385457 DOI: 10.3390/ph16070954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
The long-term use of psychopharmacology medications in autism spectrum disorder (ASD) hitherto remains controversial due to a lack of evidence about safety and tolerability. In this regard, genotyping the metabolizing enzyme cytochrome P450 (CYP) 2D6, especially its extreme phenotypes, could help to prevent drug-related adverse reactions or adverse events (AEs). There are several medications warranting CYP2D6 screening that are consumed by people with ASD, such as risperidone and aripiprazole to name a few. A naturalistic observational study was carried out in participants with ASD to analyze the influence of the CYP2D6 phenotype in drug tolerability using a local pharmacovigilance system created for this study. In this case, AEs were identified from participants' electronic health records (EHRs) and paper registries. Other variables were collected: socio-demographic information, comorbidities, and psychopharmacology prescriptions (polypharmacy defined as ≥4 simultaneous prescriptions) and doses. The genetic analysis included allelic discrimination (CYP2D6*1, *2, *3, *4, *5, *6, *10, *17, and *41) and copy number variations. All of these were used to determine theoretical phenotypes of the metabolic profiles: poor (PM); intermediate (IM); normal (NM); and ultra-rapid (UM). Sex differences were analyzed. A total of 71 participants (30 ± 10 years old, 82% male, 45% CYP2D6 NM phenotype (32 participants)) with a median of 3 (IQR 2-4) comorbidities per person, mainly urinary incontinence (32%) and constipation (22%), were included. CYP2D6 UM showed the highest rate of polypharmacy, whilst, IM participants had the highest rates of neurological and psychiatric AEs, even worse if a CYP2D6 inhibitor drug was prescribed simultaneously. CYP2D6 pharmacogenomics and the monitoring of new antipsychotic prescriptions may make a difference in medication safety in adults with ASD. Particularly in those with psychopharmacology polymedication, it can help with AE avoidance and understanding.
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Affiliation(s)
- Pura Ballester
- Pharmacology Department, Pharmacy Degree, San Antonio Catholic University, 30107 Murcia, Spain
| | - Cristina Espadas
- Bioengineering Institute, Pediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), 03202 Alicante, Spain
| | - Susana Almenara
- Neuropharmacology on Pain Treatment and Neurodevelopmental Disorders, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- Clinical Pharmacology Unit, Alicante General University Hospital, 03010 Alicante, Spain
| | - Jordi Barrachina
- Neuropharmacology on Pain Treatment and Neurodevelopmental Disorders, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Javier Muriel
- Neuropharmacology on Pain Treatment and Neurodevelopmental Disorders, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- Clinical Pharmacology, Pediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), 03202 Alicante, Spain
| | - Enrique Ramos
- Bioengineering Institute, Pediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), 03202 Alicante, Spain
| | - Natalia Toral
- San Rafael Center-San Francisco De Borja Foundation, Residential Facility, 03559 Alicante, Spain
| | - César Belda
- Infanta Leonor Center, Autism Parents Association Valencian Community Autism Association (APACV), 03010 Alicante, Spain
| | - Ana M Peiró
- Bioengineering Institute, Pediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), 03202 Alicante, Spain
- Neuropharmacology on Pain Treatment and Neurodevelopmental Disorders, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- Clinical Pharmacology Unit, Alicante General University Hospital, 03010 Alicante, Spain
- Clinical Pharmacology, Pediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), 03202 Alicante, Spain
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Agulló L, Aguado I, Muriel J, Margarit C, Gómez A, Escorial M, Sánchez A, Fernández A, Peiró AM. Pharmacogenetic Guided Opioid Therapy Improves Chronic Pain Outcomes and Comorbid Mental Health: A Randomized, Double-Blind, Controlled Study. Int J Mol Sci 2023; 24:10754. [PMID: 37445931 DOI: 10.3390/ijms241310754] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Interindividual variability in analgesic response is at least partly due to well-characterized polymorphisms that are associated with opioid dosing and adverse outcomes. The Clinical Pharmacogenetics Implementation Consortium (CPIC) has put forward recommendations for the CYP2D6 phenotype, but the list of studied drug-gene pairs continues to grow. This clinical trial randomized chronic pain patients (n = 60), referred from primary care to pain unit care into two opioid prescribing arms, one guided by CYP2D6, μ-opioid receptor (OPRM1), and catechol-O-methyl transferase (COMT) genotypes vs. one with clinical routine. The genotype-guided treatment reduced pain intensity (76 vs. 59 mm, p < 0.01) by improving pain relief (28 vs. 48 mm, p < 0.05), increased quality of life (43 vs. 56 mm p < 0.001), and lowered the incidence of clinically relevant adverse events (3 [1-5] vs. 1 [0-2], p < 0.01) and 42% opioid dose (35 [22-61] vs. 60 [40-80] mg/day, p < 0.05) as opposed to usual prescribing arm. The final health utility score was significantly higher (0.71 [0.58-0.82] vs. 0.51 [0.13-0.67] controls, p < 0.05) by improving sleepiness and depression comorbidity, with a significant reduction of 30-34% for headache, dry mouth, nervousness, and constipation. A large-scale implementation analysis could help clinical translation, together with a pharmaco-economic evaluation.
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Affiliation(s)
- Laura Agulló
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital of Alicante, c/Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202 Elche, Spain
| | - Isidro Aguado
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital of Alicante, c/Pintor Baeza, 12, 03010 Alicante, Spain
| | - Javier Muriel
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital of Alicante, c/Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202 Elche, Spain
| | - César Margarit
- Pain Unit, Department of Health of Alicante, General University Hospital of Alicante, c/Pintor Baeza, 12, 03010 Alicante, Spain
| | - Alba Gómez
- Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202 Elche, Spain
| | - Mónica Escorial
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital of Alicante, c/Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202 Elche, Spain
| | - Astrid Sánchez
- San Vicente del Raspeig II Health Center, c/Alicante, 78, Sant Vicent del Raspeig, 03690 Alicante, Spain
| | - Alicia Fernández
- San Vicente del Raspeig II Health Center, c/Alicante, 78, Sant Vicent del Raspeig, 03690 Alicante, Spain
| | - Ana M Peiró
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital of Alicante, c/Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202 Elche, Spain
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Muriel J, Escorial M, Margarit C, Barrachina J, Carvajal C, Morales D, Peiró AM. Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences. Acta Pharm 2023; 73:227-241. [PMID: 37307374 DOI: 10.2478/acph-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Javier Muriel
- 1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain
| | - Mónica Escorial
- 1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain
- 2Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
| | - César Margarit
- 1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain
- 3Pain Unit, Dr. Balmis General University Hospital, ISABIAL, c/Pintor Baeza, 12 03010, Alicante, Spain
| | - Jordi Barrachina
- 1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain
- 2Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
| | - Cristian Carvajal
- 2Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
| | - Domingo Morales
- 4Operations Research Centre, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
| | - Ana M Peiró
- 1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain
- 2Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
- 3Pain Unit, Dr. Balmis General University Hospital, ISABIAL, c/Pintor Baeza, 12 03010, Alicante, Spain
- 5Clinical Pharmacology Department, Dr. Balmis General University Hospital ISABIAL, c/Pintor Baeza, 12, 03010 Alicante, Spain
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Agulló L, Muriel J, Margarit C, Escorial M, Garcia D, Herrero MJ, Hervás D, Sandoval J, Peiró AM. Sex Differences in Opioid Response Linked to OPRM1 and COMT genes DNA Methylation/Genotypes Changes in Patients with Chronic Pain. J Clin Med 2023; 12:jcm12103449. [PMID: 37240556 DOI: 10.3390/jcm12103449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Analgesic-response variability in chronic noncancer pain (CNCP) has been reported due to several biological and environmental factors. This study was undertaken to explore sex differences linked to OPRM1 and COMT DNA methylation changes and genetic variants in analgesic response. A retrospective study with 250 real-world CNCP outpatients was performed in which data from demographic, clinical, and pharmacological variables were collected. DNA methylation levels (CpG island) were evaluated by pyrosequencing, and their interaction with the OPRM1 (A118G) and COMT (G472A) gene polymorphisms was studied. A priori-planned statistical analyses were conducted to compare responses between females and males. Sex-differential OPRM1 DNA methylation was observed to be linked to lower opioid use disorder (OUD) cases for females (p = 0.006). Patients with lower OPRM1 DNA methylation and the presence of the mutant G-allele reduced opioid dose requirements (p = 0.001), equal for both sexes. Moreover, COMT DNA methylation levels were negatively related to pain relief (p = 0.020), quality of life (p = 0.046), and some adverse events (probability > 90%) such as constipation, insomnia, or nervousness. Females were, significantly, 5 years older with high anxiety levels and a different side-effects distribution than males. The analyses demonstrated significant differences between females and males related to OPRM1 signalling efficiency and OUD, with a genetic-epigenetic interaction in opioid requirements. These findings support the importance of sex as a biological variable to be factored into chronic pain-management studies.
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Affiliation(s)
- Laura Agulló
- Pharmacogenetic Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202 Elche, Spain
| | - Javier Muriel
- Pharmacogenetic Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Pintor Baeza, 12, 03010 Alicante, Spain
| | - César Margarit
- Pain Unit, Department of Health of Alicante, Dr. Balmis General University Hospital, c/Pintor Baeza, 12, 03010 Alicante, Spain
| | - Mónica Escorial
- Pharmacogenetic Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202 Elche, Spain
| | - Diana Garcia
- Epigenomics Core Facility, La Fe Health Research Institute, Ave. Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - María José Herrero
- Pharmacogenetics Unit, La Fe Health Research Institute, Ave. Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - David Hervás
- Department of Applied Statistics and Operations Research and Quality, Universitat Politècnica de Valéncia, 46022 Valencia, Spain
| | - Juan Sandoval
- Epigenomics Core Facility, La Fe Health Research Institute, Ave. Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Ana M Peiró
- Pharmacogenetic Unit, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Pintor Baeza, 12, 03010 Alicante, Spain
- Clinical Pharmacology, Toxicology and Chemical Safety Unit, Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202 Elche, Spain
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Barrachina J, Margarit C, Muriel J, López-Gil S, López-Gil V, Vara-González A, Planelles B, Inda MDM, Morales D, Peiró AM. Oxycodone/naloxone versus tapentadol in real-world chronic non-cancer pain management: an observational and pharmacogenetic study. Sci Rep 2022; 12:10126. [PMID: 35710811 PMCID: PMC9203709 DOI: 10.1038/s41598-022-13085-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/20/2022] [Indexed: 12/25/2022] Open
Abstract
Tapentadol (TAP) and oxycodone/naloxone (OXN) potentially offer an improved opioid tolerability. However, real-world studies in chronic non-cancer pain (CNCP) remain scarce. Our aim was to compare effectiveness and security in daily pain practice, together with the influence of pharmacogenetic markers. An observational study was developed with ambulatory test cases under TAP (n = 194) or OXN (n = 175) prescription with controls (prescribed with other opioids (control), n = 216) CNCP patients. Pain intensity and relief, quality of life, morphine equivalent daily doses (MEDD), concomitant analgesic drugs, adverse events (AEs), hospital frequentation and genetic variants of OPRM1 (rs1799971, A118G) and COMT (rs4680, G472A) genes, were analysed. Test CNCP cases evidenced a significantly higher pain relief predictable due to pain intensity and quality of life (R2 = 0.3), in front of controls. Here, OXN achieved the greatest pain relief under a 28% higher MEDD, 8–13% higher use of pregabalin and duloxetine, and 23% more prescription change due to pain, compared to TAP. Whilst, TAP yielded a better tolerability due the lower number of 4 [0–6] AEs/patient, in front of OXN. Furthermore, OXN COMT-AA homozygotes evidenced higher rates of erythema and vomiting, especially in females. CNCP real-world patients achieved higher pain relief than other traditional opioids with a better tolerability for TAP. Further research is necessary to clarify the potential influence of COMT and sex on OXN side-effects.
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Affiliation(s)
- Jordi Barrachina
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Cesar Margarit
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Pain Unit, Department of Health of Alicante - General Hospital, Alicante, Spain
| | - Javier Muriel
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Pain Unit, Department of Health of Alicante - General Hospital, Alicante, Spain
| | - Santiago López-Gil
- Occupational Observatory, Miguel Hernández University of Elche, Alicante, Spain
| | - Vicente López-Gil
- Occupational Observatory, Miguel Hernández University of Elche, Alicante, Spain
| | - Amaya Vara-González
- Occupational Observatory, Miguel Hernández University of Elche, Alicante, Spain
| | - Beatriz Planelles
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Elche, Spain
| | - María-Del-Mar Inda
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Domingo Morales
- Operations Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Ana M Peiró
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain. .,Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Elche, Spain. .,Clinical Pharmacology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain. .,Neuropharmacology on Pain (NED) Research Group, Hospital General Universitario de Alicante, C/Pintor Baeza, 12, 03010, Alicante, Spain.
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9
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Ballester P, Muriel J, Peiró AM. CYP2D6 phenotypes and opioid metabolism: the path to personalized analgesia. Expert Opin Drug Metab Toxicol 2022; 18:261-275. [PMID: 35649041 DOI: 10.1080/17425255.2022.2085552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Opioids play a fundamental role in chronic pain, especially considering when 1 of 5 Europeans adults, even more in older females, suffer from it. However, half of them do not reach an adequate pain relief. Could pharmacogenomics help to choose the most appropriate analgesic drug? AREAS COVERED The objective of the present narrative review was to assess the influence of cytochrome P450 2D6 (CYP2D6) phenotypes on pain relief, analgesic tolerability, and potential opioid misuse. Until December 2021, a literature search was conducted through the MEDLINE, PubMed database, including papers from the last 10 years. CYP2D6 plays a major role in metabolism that directly impacts on opioid (tramadol, codeine, or oxycodone) concentration with differences between sexes, with a female trend toward poorer pain control. In fact, CYP2D6 gene variants are the most actionable to be translated into clinical practice according to regulatory drug agencies and international guidelines. EXPERT OPINION CYP2D6 genotype can influence opioids' pharmacokinetics, effectiveness, side effects, and average opioid dose. This knowledge needs to be incorporated in pain management. Environmental factors, psychological together with genetic factors, under a sex perspective, must be considered when you are selecting the most personalized pain therapy for your patients.
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Affiliation(s)
- Pura Ballester
- Neuropharmacology on Pain (NED) group, Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain
| | - Javier Muriel
- Neuropharmacology on Pain (NED) group, Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain
| | - Ana M Peiró
- Neuropharmacology on Pain (NED) group, Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
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10
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Ballester P, Espadas C, Londoño AC, Almenara S, Aguilar V, Belda C, Pérez E, Muriel J, Peiró AM. The challenge of detecting adverse events in adults with autism spectrum disorder who have intellectual disability. Autism Res 2021; 15:192-202. [PMID: 34652075 DOI: 10.1002/aur.2624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/15/2021] [Accepted: 09/26/2021] [Indexed: 11/09/2022]
Abstract
Adults with autism spectrum disorder (ASD) and associated intellectual disability (ID) take a high number of different psychotropic drugs simultaneously. Nowadays, little is known about this multidrug pattern efficacy and safety. The present study has endeavored to fill this gap creating a local pharmacovigilance system. A 36-month, retrospective and prospective, observational, and multicenter pharmacovigilance study was carried out in adults with ASD and ID (n = 83). Information regarding ongoing medications (polypharmacy: taking simultaneously >4 drugs; safety profile: adverse events' number, adverse drug reactions' number, and affected system; and observed-to-expected [O/E] ratio using the summary of product characteristics), and current diagnoses were recorded. A median of four ongoing medications per participant was registered, half of the sample was under polypharmacy regimen. Regarding all ongoing medications, 50% were antipsychotic drugs, and 47% of participants had >1 antipsychotic prescribed. In contrast, only 64 adverse events were identified from electronic health records, mostly due to risperidone. Half of them were related either to nervous or metabolic systems, and almost a third were not previously described in the corresponding drug summary of products characteristics. Extrapyramidalism, gynecomastia, hypercholesterolemia, and urinary retention were some AEs that occurred more frequently than expected (O/E ratio > 6 times) according to our data. The highest O/E ratio scores (>120 times) were for hypercholesterolemia and rhabdomyolysis caused by valproic acid. According to the number of adverse events and adverse drug reactions reported in electronic health records locally and nationally by clinicians, we need to increase awareness about medications safety. LAY SUMMARY: A 36-month study in adults with autism, ID, and polypharmacy (>4 drugs) was done to investigate drug safety on everyone. A median of four medications per person was registered, half were antipsychotic drugs, and 47% of participants had >1 antipsychotic medication simultaneously. Only 64 adverse events were identified from electronic health records, mostly due to risperidone. Half of them were related to nervous or metabolic systems and a third were not previously described in the drug information sheet.
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Affiliation(s)
- Pura Ballester
- Clinical Pharmacology, Paediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Cristina Espadas
- Clinical Pharmacology, Paediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), Alicante, Spain
| | - Ana C Londoño
- Clinical Psychiatry and Psychology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
| | - Susana Almenara
- Clinical Pharmacology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
| | - Victor Aguilar
- San Rafael Centre - San Francisco De Borja Foundation, Residential Facility, Alicante, Spain
| | - Cesar Belda
- Infanta Leonor Center, Autism Parents Association Valencian Community Autism Association (APACV), Alicante, Spain
| | - Enrique Pérez
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.,Clinical Psychiatry and Psychology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
| | - Javier Muriel
- Clinical Pharmacology, Paediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Ana M Peiró
- Clinical Pharmacology, Paediatrics and Organic Chemistry Department, Miguel Hernández University of Elche (UMH), Alicante, Spain.,Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
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11
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Affiliation(s)
- Thomas Zandonai
- Sports Research Centre, Department of Sport Sciences, Miguel Hernández University of Elche, Elche, Spain.,Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Elche, Spain
| | - Mónica Escorial
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Elche, Spain.,Neuropharmacology on Pain and Functional Diversity (NED), Institute of Health and Biomedical Research of Alicante (ISABIAL Foundation), Alicante, Spain
| | - Ana M Peiró
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Elche, Spain.,Neuropharmacology on Pain and Functional Diversity (NED), Institute of Health and Biomedical Research of Alicante (ISABIAL Foundation), Alicante, Spain.,Pain Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
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12
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Abstract
Genome-wide association studies and candidate gene findings suggest that genetic approaches may help in choosing the most appropriate drug and dosage, while preventing adverse drug reactions. This is the field that addresses precision medicine: to evaluate variations in the DNA sequence that could be responsible for different individual analgesic response. We review potential gene biomarkers with best overall convergent functional evidence, for opioid use, in pain management. Polymorphisms can modify pharmacodynamics (i.e., mu opioid receptor, OPRM1) and pharmacokinetics (i.e., CYP2D6 phenotypes) pathways altering opioid effectiveness, consumption, side effects or additionally, prescription opioid use dependence vulnerability. This review provides a summary of these candidate variants for the translation of genotype into clinically useful information in pain medicine.
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Affiliation(s)
- Mongi Benjeddou
- Department of Biotechnology, University of The Western Cape, Robert Sobukwe Road, Bellville 7535, Cape Town, Western Cape, South Africa
| | - Ana M Peiró
- Neuropharmacology on Pain & Functional Diversity (NED), Alicante Institute for Health & Biomedical Research (ISABIAL), Alicante, Spain
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13
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Gombert M, Ballester P, Segura A, Peiró AM. Introducing sexual dysfunction in mental care. Expert Opin Drug Saf 2020; 20:69-79. [PMID: 33191796 DOI: 10.1080/14740338.2020.1849135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: People with any psychiatric disorder tend to have difficulties in responding sexually. However,sexual dysfunction (SD) is usually under-recognized, even the tightly hormonal and neuronal common connexions through the brain-sex axis. Multiple sources of resistance to SD assessment and intervention persist. Areas covered: The present review aims to underline the feasibility to introduce SD evaluation in patients with any psychiatric disorders, evaluating the potential mutual benefits of their management. Expert opinion: Women and men living with mental disorders frequently display sexual difficulties; however, some of them consider sexuality as a relevant parameter of their quality of life. In fact, SD as a side effect is a frequent reason for stopping the intake of medication. What is more, a holistic approach integrating sexual function could foster a better understanding of mental pathologies due to a common origin of pathogenesis. This could improve care quality, in keeping with the global tendency toward the development of personalized medicine. Consistently, the integration of SD assessment is highly recommended in mental health, all the more so when a psychotropic drug is prescribed. An expected consequence would be a reconstruction of the healthcare professional's consideration for the sexuality of people experiencing mental disorders.
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Affiliation(s)
- Marie Gombert
- Department of Paediatrics, Obstetrics and Gynecology, University of Valencia , Valencia, Spain
| | - Pura Ballester
- Department of Pharmacology, Paediatrics and Organic Chemistry , Alicante, Spain.,Neuropharmacology on Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL) , Alicante, Spain
| | - Ana Segura
- Andrology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain
| | - Ana M Peiró
- Department of Pharmacology, Paediatrics and Organic Chemistry , Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante - General Hospital, Alicante, Spain
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14
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Pena MÁ, Muriel J, Saiz-Rodríguez M, Borobia AM, Abad-Santos F, Frías J, Peiró AM. Effect of Cytochrome P450 and ABCB1 Polymorphisms on Imatinib Pharmacokinetics After Single-Dose Administration to Healthy Subjects. Clin Drug Investig 2020; 40:617-628. [PMID: 32415468 DOI: 10.1007/s40261-020-00921-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Validated genomic biomarkers for oncological drugs are expanding to improve targeted therapies. Pharmacogenetics research focusing on the mechanisms underlying imatinib suboptimal response might help to explain the different treatment outcomes and drug safety profiles. OBJECTIVE To investigate whether polymorphisms in genes encoding cytochrome P450 (CYP) enzymes and ABCB1 transporter affect imatinib pharmacokinetic parameters. METHODS A prospective, multicenter, pharmacogenetic pilot study was performed in the context of two separate oral imatinib bioequivalence clinical trials, which included 26 healthy volunteers. DNA was extracted in order to analyze polymorphisms in genes CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A4, CYP3A5 and ABCB1. Imatinib plasma concentrations were measured by HPLC-MS/MS. Pharmacokinetic parameters were calculated by non-compartmental methods using WinNonlin software. RESULTS Volunteers (n = 26; aged 24 ± 3 years; 69% male) presented regular pharmacokinetic imatinib data (concentration at 24 h, 436 ± 140 ng/mL and at 72 h, 40 ± 26 ng/mL; AUC0-72 32,868 ± 10,713 ng/mL⋅h; and Cmax 2074 ± 604 ng/mL). CYP2B6 516GT carriers showed a significant reduction of imatinib concentration at 24 h (23%, 391 ng/dL vs 511 ng/dL in 516GG carriers, p = 0.005) and elimination half-life (11%, 12.6 h vs 14.1 h in 516GG carriers, p = 0.041). Carriers for CYP3A4 (*22/*22, *1/*20 and *1/*22 variants) showed a reduced frequency of adverse events compared to *1/*1 carriers (0 vs 64%, p = 0.033). The other polymorphisms analyzed did not influence pharmacokinetics or drug toxicity. CONCLUSION CYP2B6 G516T and CYP3A4 *20,*22 polymorphisms could influence imatinib plasma concentrations and safety profile, after single-dose administration to healthy subjects. This finding needs to be confirmed before it is implemented in clinical practice in oncological patients under treatment with imatinib.
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Affiliation(s)
- María Ángeles Pena
- Alicante Clinical Trials Unit, Department of Health, Alicante-General Hospital, Alicante, Spain.,Clinical Pharmacology Service, Department of Health, Alicante-General Hospital, c/Pintor Baeza, 12, 03010, Alicante, Spain
| | - Javier Muriel
- Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain
| | - Miriam Saiz-Rodríguez
- Clinical Pharmacology Service, University Hospital La Princesa, Autonomous University of Madrid, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, La Paz University Hospital, Universidad Autónoma de Madrid. IdiPAZ, Madrid, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Service, University Hospital La Princesa, Autonomous University of Madrid, Madrid, Spain.,Institute Teófilo Hernando for Drug I+D, School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Jesús Frías
- Clinical Pharmacology Department, La Paz University Hospital, Universidad Autónoma de Madrid. IdiPAZ, Madrid, Spain
| | - Ana M Peiró
- Alicante Clinical Trials Unit, Department of Health, Alicante-General Hospital, Alicante, Spain. .,Clinical Pharmacology Service, Department of Health, Alicante-General Hospital, c/Pintor Baeza, 12, 03010, Alicante, Spain.
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15
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Ors D, Segura A, Arrarte V, Ballester P, Muriel J, Fernández G, Soriano J, Peiró AM. [Erectile dysfunction in patients with cardiovascular disease and the potential influence of genetic markers]. Rev Int Androl 2020; 19:217-223. [PMID: 32753341 DOI: 10.1016/j.androl.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/13/2020] [Accepted: 03/13/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The association between erectile dysfunction (ED) and cardiovascular disease (CVD) is well known, the latter being an early independent risk factor that can appear up to 5 years before the onset of cardiovascular symptoms. The enzyme endothelial nitric oxide synthase (eNOS) could be implicated in its pathophysiology as an endogenous vasodilator. Our objective was to analyse the influence of variants of the eNOS gene, in the response to treatment of ED, in patients with CVD. METHODOLOGY Observational, prospective study in patients with ED of the Cardiac Rehabilitation Programme. Demographic variables were collected (International Index of Erectile Function (IIEF), quality of sexual life (mSLQQ), anxiety and depression (HAD), along with cardiovascular risk factors (CVRF). Genetic analysis of polymorphisms T-786C, G894T of the eNOS gene was performed by RT-PCR with TaqMan probe, and the data were analysed using SPSS 25. RESULTS Patients (n = 35, 60.8 ± 8.44 years) showed a median CVD (IQR 1-3) with severe ED (IIEF-EF of 9.4 ± 6.73 points) and a low perception of their quality of sexual life (-19.4 ± 8.37 points). At the final visit (n = 15), there were 71% responders to treatment with iPDE5, with a significant improvement in their ED (IIEF = 49.4 ± 17.29, IIEF-FE = 18.5 ± 9.60 scores) and of their quality of sexual life (7 ± 12 scores), with a higher percentage of responders among the native homozygous genotypes -786-TT and 864-TT. CONCLUSION Variants of the NOS3 gene could influence the response to iPDE5. Full analysis of the patient sample will be required to confirm these preliminary results.
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Affiliation(s)
- Diego Ors
- Observatorio Ocupacional, Universidad Miguel Hernández (UMH), Elche, España
| | - Ana Segura
- Unidad de Andrología, Servicio de Urología, Hospital General Universitario de Alicante (HGUA), España
| | - Vicente Arrarte
- Neurofarmacología del dolor (NED), Unidad de Investigación, Departamento de Salud de Alicante, Hospital General, ISABIAL, Alicante, España
| | - Pura Ballester
- Servicio de Cardiología, Hospital General Universitario de Alicante (HGUA), España
| | - Javier Muriel
- Servicio de Cardiología, Hospital General Universitario de Alicante (HGUA), España
| | - Guillermina Fernández
- Unidad de Andrología, Servicio de Urología, Hospital General Universitario de Alicante (HGUA), España
| | - Josefa Soriano
- Servicio de Cardiología, Hospital General Universitario de Alicante (HGUA), España
| | - Ana M Peiró
- Servicio de Cardiología, Hospital General Universitario de Alicante (HGUA), España; Unidad de Farmacología Clínica, Hospital General Universitario de Alicante (HGUA), España.
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16
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Ballester P, Richdale AL, Baker EK, Peiró AM. Sleep in autism: A biomolecular approach to aetiology and treatment. Sleep Med Rev 2020; 54:101357. [PMID: 32759030 DOI: 10.1016/j.smrv.2020.101357] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 01/24/2023]
Abstract
People with autism spectrum disorder (ASD) commonly experience other comorbidities. Studies indicate that between 50% and 83% of individuals with ASD have sleep problems or disorders. The most commonly reported sleep problems are: (a) insomnia symptoms including the inability to get to sleep or stay asleep; and (b) circadian rhythm sleep-wake disorders, defined as a misalignment between the timing of endogenous circadian rhythms and the external environment. The circadian system provides timing information for the sleep-wake cycle that is regulated by the interaction of an endogenous processes (circadian - Process C, and homeostatic - Process S) and synchronizing agents (neurohormones and neurotransmitters), which produce somnogenic activity. A clinical priority in ASD is understanding the cause of these sleep problems in order to improve treatment outcomes. This review approaches sleep in autism from several perspectives: Sleep-wake mechanisms and problems, and brain areas and molecules controlling sleep (e.g., GABA and melatonin) and wake maintenance (e.g., serotonin, acetylcholine and glutamate). Specifically, this review examines how altered sleep structure could be related to neurobiological alterations or genetic mutations and the implications this may have for potential pharmacological treatments in individuals with ASD.
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Affiliation(s)
- P Ballester
- Neuropharmacology on Pain and Functional Diversity (NED) Research Group, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Pharmacology, Organic Chemistry and Pediatrics, Miguel Hernández University of Elche, Elche, Spain.
| | - A L Richdale
- Olga Tennison Autism Research Centre, School of Psychology & Public Health, La Trobe University, Melbourne, Australia
| | - E K Baker
- Diagnosis and Development, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - A M Peiró
- Neuropharmacology on Pain and Functional Diversity (NED) Research Group, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Pharmacology, Organic Chemistry and Pediatrics, Miguel Hernández University of Elche, Elche, Spain
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17
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Ruiz-Cantero MT, Blasco-Blasco M, Chilet-Rosell E, Peiró AM. Gender bias in therapeutic effort: from research to health care. Farm Hosp 2020; 44:109-113. [PMID: 32452310 DOI: 10.7399/fh.11394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
There are relevant dimensions from a gender perspective related to therapeutic effort. To illustrate and discuss possible gender bias related to medicines, through the consumption analysis in women, the prescription of biological drugs according to sex, the potential gender inequality in adverse drug reactions, and research with clinical trials, as well as the decisions of international institutions in the marketing of medicinal products. There is greater tendency to prescribe pain relievers, regardless of pain, and drugs for low intensity depressive symptoms in women than in men. The opposite occurs in the prescription of statins and adequate doses, and with the greater probability of prescribing anti-tumor necrosis factor in men than in women with ankylosing spondylitis, despite a similar disease burden. Adverse drug reactions are observed more frequently in women than in men, where determinants such as body weight are having little influence on the dosage. It is currently scarcely considered in the prescription that women have differences in the activity of cytochrome CYPP450 enzymes, which can affect the liver's metabolism rate. There are even immunological, genetic and epigenetic effects (due to heredity and uneven gene dosing located in the X and Y chromosomes) that can influence these differences by sex. Finally, through cases of hormonal therapy clinical trials, a drug for women's inhibited sexual desire and a contraceptive for men, gender bias and stereotypes are shown to influence a potential generation of inequalities, especially in adverse drug reactions to the detriment of women. In conclusion, health professionals frequently attribute physical symptoms to women's emotionality, influencing their greater prescription of symptomatic drugs. Whether the same reason influences the lower prescription of therapeutic drugs in women than in men should be analyzed. There are biological determinants to consider due to their influence on a greater pharmacological toxicity in women. Clinical trials should improve according to the gender recommendations by the Food and Drugs Administration.
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Affiliation(s)
- María Teresa Ruiz-Cantero
- Public Health Research Group. Universidad de Alicante, San Vicente del Raspeig (Alicante), Spain Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid. Spain.
| | - Mar Blasco-Blasco
- Public Health Research Group. Universidad de Alicante, San Vicente del Raspeig (Alicante), Spain Department of Public Health, History of Science and Gynecology, Universidad Miguel Hernández, Elche. Spain.
| | - Elisa Chilet-Rosell
- Universidad Miguel Hernández, Elche. Spain. 4 Clinical Pharmacology Unit and Instituto de Investigación Sanitaria y Biomédica de ISABIAL. Hospital General de Alicante, Alicante. Spain Department of Public Health, History of Science and Gynecology, Universidad Miguel Hernández, Elche. Spain.
| | - Ana M Peiró
- Clinical Pharmacology Unit and Instituto de Investigación Sanitaria y Biomédica de ISABIAL. Hospital General de Alicante, Alicante. Spain.
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18
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Peiró AM, García-Gutiérrez MS, Planelles B, Femenía T, Mingote C, Jiménez-Treviño L, Martínez-Barrondo S, García-Portilla MP, Saiz PA, Bobes J, Manzanares J. Association of cannabinoid receptor genes ( CNR1 and CNR2) polymorphisms and panic disorder. Anxiety Stress Coping 2020; 33:256-265. [PMID: 32114795 DOI: 10.1080/10615806.2020.1732358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background and objectives: Panic disorder (PD) is an anxiety disorder characterized by recurrent and unexpected panic attacks along with sudden onset of apprehension, fear or terror. The endocannabinoid system (ECS) has a role in stress recovery, regulating anxiety. The aim of this study was to analyze potential genetic alterations in key ECS targets in patients suffering from panic disorders.Design and methods: We analyzed single nucleotide polymorphisms (SNPs) of the cannabinoid receptors (CNR1; CNR2) and the endocannabinoid hydrolytic enzyme fatty acid amide hydrolase (FAAH) genes in 164 Spanish PD patients and 320 matched controls.Results: No significant differences were observed in the SNPs of the CNR2 and FAAH genes tested. However, when analyzing genotype-by-sex interaction at A592G (rs2501431) and C315T (rs2501432) in the CNR2 gene, the presence of the G-allele in males was associated with a protective haplotype. Genotyping analysis revealed that variants in CNR1 confer vulnerability to PD, with a significantly increased risk associated with the G-allele (rs12720071) and C-allele (rs806368). This finding was consistent when analyzing genotype-by-sex interaction, where females presented a greater PD risk.Conclusions: Polymorphisms at the CNR1 gene may be a risk factor for PD contributing to sex-specific dysfunction in females.
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Affiliation(s)
- Ana M Peiró
- Clinical Pharmacology Unit and Neuropharmacology on Pain and Functional Diversity (NED), Department of Health of Alicante - General Hospital, ISABIAL, Alicante, Spain
| | - María S García-Gutiérrez
- Neuroscience Institute, Alicante, Miguel Hernández University, San Juan de Alicante, Spain.,Cooperative Networking in Health Research (RETICS-addictive disorders), Health Institute Carlos III, MICINN and FEDER, Madrid, Spain
| | | | - Teresa Femenía
- Neuroscience Institute, Alicante, Miguel Hernández University, San Juan de Alicante, Spain
| | | | - Luis Jiménez-Treviño
- Psychiatry Department, Medicine Faculty, University of Oviedo; Biomedical Research Centre in Mental Health Network (CIBERSAM); University Institute of Neuroscience of Asturias, INEUROPA; Health Service of Asturias, SESPA, Asturias, Spain
| | - Sara Martínez-Barrondo
- Psychiatry Department, Medicine Faculty, University of Oviedo; Biomedical Research Centre in Mental Health Network (CIBERSAM); University Institute of Neuroscience of Asturias, INEUROPA; Health Service of Asturias, SESPA, Asturias, Spain
| | - M Paz García-Portilla
- Psychiatry Department, Medicine Faculty, University of Oviedo; Biomedical Research Centre in Mental Health Network (CIBERSAM); University Institute of Neuroscience of Asturias, INEUROPA; Health Service of Asturias, SESPA, Asturias, Spain
| | - Pilar A Saiz
- Psychiatry Department, Medicine Faculty, University of Oviedo; Biomedical Research Centre in Mental Health Network (CIBERSAM); University Institute of Neuroscience of Asturias, INEUROPA; Health Service of Asturias, SESPA, Asturias, Spain
| | - Julio Bobes
- Psychiatry Department, Medicine Faculty, University of Oviedo; Biomedical Research Centre in Mental Health Network (CIBERSAM); University Institute of Neuroscience of Asturias, INEUROPA; Health Service of Asturias, SESPA, Asturias, Spain
| | - Jorge Manzanares
- Neuroscience Institute, Alicante, Miguel Hernández University, San Juan de Alicante, Spain.,Cooperative Networking in Health Research (RETICS-addictive disorders), Health Institute Carlos III, MICINN and FEDER, Madrid, Spain
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Ballester P, Martínez MJ, Inda MDM, Javaloyes A, Richdale AL, Muriel J, Belda C, Toral N, Morales D, Fernández E, Peiró AM. Evaluation of agomelatine for the treatment of sleep problems in adults with autism spectrum disorder and co-morbid intellectual disability. J Psychopharmacol 2019; 33:1395-1406. [PMID: 31423939 DOI: 10.1177/0269881119864968] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Intellectual disability (ID) and autism spectrum disorder (ASD) are common, co-occurring developmental disorders and are frequently associated with sleep problems. This study aimed to assess the effectiveness and tolerability of agomelatine as a pharmacotherapy for sleep problems in ASD adults with ID. METHOD A randomised, crossover, triple-blind, placebo-controlled clinical trial, with two three-month periods of treatment starting with either agomelatine or placebo and a washout period of two weeks. Ambulatory circadian monitoring (24 hours/7 days) evaluated total sleep time (TST) as the primary outcome variable. RESULTS Participants (N=23; 35±12 years old; 83% male) had a median of three (interquartile range (IQR) 1-4) co-morbidities and were taking a median of five (IQR 2-7) prescribed drugs. Before agomelatine or placebo treatment, all subjects presented with insomnia symptoms, including sleep latency (100% abnormal, 55±23 minutes) or TST (55% abnormal, 449±177 minutes), and 66% had circadian rhythm sleep-wake abnormalities with rhythm phase advancements according to the M5 sleep phase marker values. During the three-month agomelatine treatment, night TST significantly increased by a mean of 83 minutes (16% abnormal, 532±121 minutes), together with a phase correction (M5 1:45±2:28 hours vs. 3:15±2:20 hours), improving sleep stability in wrist temperature rhythm (0.43±0.29 vs. 0.52±0.18 AU). Adverse events were mild and transient. CONCLUSIONS Agomelatine was effective and well tolerated for treating insomnia and circadian rhythm sleep problems present in adults with ASD and ID.
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Affiliation(s)
- Pura Ballester
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Department of Clinical Pharmacology, Organic Chemistry and Paediatrics, Miguel Hernández University of Elche, Elche, Spain
| | - María José Martínez
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, Murcia Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - María-Del-Mar Inda
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Auxiliadora Javaloyes
- Education Centre for Children and Adolescents with Autism, Mental Health Problems and Behavioural Disorders (EDUCATEA), Alicante, Spain
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Javier Muriel
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - César Belda
- Infanta Leonor Autism Centre, Alicante, Spain
| | | | - Domingo Morales
- Operations Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Eduardo Fernández
- Bioengineering Institute, Miguel Hernández University of Elche, Elche, Spain
| | - Ana M Peiró
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Clinical Pharmacology Department, Department of Health of Alicante, Alicante General Hospital, Alicante, Spain
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20
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Margarit C, Roca R, Inda MDM, Muriel J, Ballester P, Moreu R, Conte AL, Nuñez A, Morales D, Peiró AM. Genetic Contribution in Low Back Pain: A Prospective Genetic Association Study. Pain Pract 2019; 19:836-847. [PMID: 31269327 DOI: 10.1111/papr.12816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/19/2019] [Accepted: 06/06/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Chronic pain is one of the most common reasons individuals seek medical attention. It is a major issue because of the wide interindividual variability in the analgesic response. This might be partly explained by the presence of variants in genes encoding molecules involved in pharmacodynamics and pharmacokinetics. The aim was to analyze opioid effectiveness in chronic low back pain (CLBP) relief after opioid titration, unveiling the impact of pharmacogenetics. METHODS The study included 231 opioid-naïve patients from the Spine Unit; age 63 ± 14 years, 64% female, body mass index 29 ± 6 kg/m2 , visual analog scale pain intensity score 73 ± 16 mm. Clinical data were collected at baseline, 3 months after opioid titration, and after 2 to 4 years of follow-up concerning pain (intensity and relief), quality of life, disability, comorbidities, and drug prescription (opioid dose, rotations, and adverse events). The genotype influence of OPRM1, COMT, UGT2B7, ABCB1, KCNJ6, and CYP3A5*3A in analgesic response was analyzed by reverse-transcription polymerase chain reaction genotyping. RESULTS Patients with the COMT G472A-AA genotype (rs4680) and KCNJ6 A1032G-A allele (rs2070995) CLBP responded differently to opioid titration, with higher pain intensity requiring higher dosing. Furthermore, GG- genotypes of A118G (OPRM1, rs1799971) and A854G (UGT2B7, rs776746) influenced the neuropathic component. After opioid titration, CLBP intensity, neuropathic component, low back pain disability, anxiety, and depression significantly decreased, while quality of life improved. CONCLUSION Single-nucleotide polymorphisms in genes involved in pain transmission and opioid metabolism might predispose to exaggerated sensitivity and differences in the opioid analgesic effect in patients with CLBP. We encourage clinical trials for their clinical application in chronic pain management.
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Affiliation(s)
- César Margarit
- Pain Unit, Department of Health of Alicante, Alicante General Hospital, Alicante, Spain.,Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Reyes Roca
- Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - María-Del-Mar Inda
- Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Javier Muriel
- Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Pura Ballester
- Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Rocío Moreu
- Clinical Pharmacology Unit, Department of Health of Alicante, Alicante General Hospital, Alicante, Spain
| | - Anna Lucia Conte
- Occupational Observatory, Miguel Hernández University of Elche, Alicante, Spain
| | - Angela Nuñez
- Operations Research Center, Miguel Hernández University of Elche, Elche, Spain
| | - Domingo Morales
- Operational Centre, Miguel Hernandez University, Elche, Spain
| | - Ana M Peiró
- Pain Unit, Department of Health of Alicante, Alicante General Hospital, Alicante, Spain.,Neuropharmacology in Pain (NED) Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante, Alicante General Hospital, Alicante, Spain
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Rodríguez Vicente AE, Herrero Cervera MJ, Bernal ML, Rojas L, Peiró AM. Personalized medicine into health national services: barriers and potentialities. Drug Metab Pers Ther 2019; 33:159-163. [PMID: 30391933 DOI: 10.1515/dmpt-2018-0017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/03/2018] [Indexed: 11/15/2022]
Abstract
Research and innovation in personalized medicine (PM) are extensive and expanding, with several pharmacogenetic/pharmacogenomic (PGx) testing options currently available for a wide range of health problems. However, PGx-guided therapy faces many barriers to full integration into clinical practice and acceptance by practitioner/patient: utilization and uptake by payers in real-world practice are being discussed, and the criteria to guide clinicians and policy makers in PGx test selection are not fully incorporated. This review focuses on the advances of pharmacogenomics to individualize treatments, the relationship between pharmacogenetics and pharmacometabolomics, the new paradigm of the Big Data, the needs and barriers facing PGx clinical application and the situation of PGx testing in health national services. It is based on lectures presented by speakers of the European Society of Pharmacogenomics and Personalised Therapy (ESPT) Fourth Conference, held in Catania, October 4th, 2017.
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Affiliation(s)
- Ana E Rodríguez Vicente
- Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-USAL-CSIC, University Hospital of Salamanca, Salamanca, Spain
| | - Maria José Herrero Cervera
- Pharmacology Department, Faculty of Medicine, Universidad Valencia and Instituto Investigación Sanitaria La Fe, Valencia, Spain
| | - María Luisa Bernal
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
- Aragon Health Research Institute, Zaragoza, Spain
| | - Luis Rojas
- Department of Internal Medicine, Pharmacology and Toxicology Unit, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Ana M Peiró
- Neuropharmacology on Pain (NED) Research Group, Clinical Pharmacology Unit, Department of Health of Alicante - General Hospital, ISABIAL, c/ Pintor Baeza, 12, 03010 Alicante, Spain
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22
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Segura A, Ballester P, Ajo R, Inda MDM, Urbano A, Muriel J, Ochando I, Margarit C, Martinez E, Peiró AM. Endothelial nitric oxide synthase gene polymorphisms and erectile dysfunction in chronic pain. Gene 2019; 1:100005. [PMID: 32550542 PMCID: PMC7285905 DOI: 10.1016/j.gene.2019.100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/29/2018] [Accepted: 12/17/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate whether endothelial nitric oxide synthase (eNOS) T786C, 4VNTR and G894 T gene polymorphisms could mediate in andrological treatment response in Spaniards. SUBJECT PATIENTS/METHODS The study participants were Spaniard males with erectile dysfunction (ED) and chronic pain (n = 105) recruited at the Pain Unit. eNOS polymorphisms were genotyped by quantitative polymerase chain reaction using Taqman specific probes. Statistical analyses were carried out using R-3.2.4 software. RESULTS A total of 69 patients required andrological treatment and 76% of them improved ED upon iPED5 (20%), testosterone (35%) or iPDE5/testosterone treatment (45%); being significantly better in T786C-CC patients. Multivariate regression analysis indicated that age, opioid daily dose and carriage of T786C-C allele influenced the risk and ED severity in Spaniard chronic pain patients. CONCLUSION T786C polymorphism at eNOS locus appeared to be a major contributor in the variable erectile function iPDE5/testosterone response in Spaniards.
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Key Words
- BMI, body mass index
- CNP, chronic non-cancer pain
- Chronic pain
- ED, erectile dysfunction
- EF, Erectile function
- Erectile dysfunction
- IIEF, International Index of Erectile Function
- NO, nitric oxide
- Pharmacogenetics
- T786C
- VAS, Visual analogue scale
- cGMP, 3′,5′-cyclic guanosine monophosphate
- eNOS gene
- eNOS, endothelial nitric oxide synthase
- iPDE5
- iPDE5, phosphodiesterase type 5 inhibitors
- mSLQQ-QOL, modified Sexual Life Quality Questionnaire
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Affiliation(s)
- Ana Segura
- Andrology Unit, University General Hospital of Alicante (HGUA), Alicante, Spain
- Neuropharmacology on Pain Research Unit, Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO), Alicante, Spain
| | - Pura Ballester
- Neuropharmacology on Pain Research Unit, Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO), Alicante, Spain
| | - Raquel Ajo
- Neuropharmacology on Pain Research Unit, Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO), Alicante, Spain
| | - María-del-Mar Inda
- Neuropharmacology on Pain Research Unit, Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO), Alicante, Spain
| | - Antonio Urbano
- Genetics Unit, Clínica Vistahermosa HLA-Hospital, Alicante, Spain
- Histology and Anatomy Department, Miguel Hernández University (UMH), Alicante, Spain
| | - Javier Muriel
- Neuropharmacology on Pain Research Unit, Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO), Alicante, Spain
- Occupational Observatory, University Miguel Hernández of Elche (UMH), Alicante, Spain
| | - Isabel Ochando
- Genetics Unit, Clínica Vistahermosa HLA-Hospital, Alicante, Spain
- Histology and Anatomy Department, Miguel Hernández University (UMH), Alicante, Spain
| | - César Margarit
- Neuropharmacology on Pain Research Unit, Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO), Alicante, Spain
- Pain Unit, HGUA, Alicante, Spain
| | | | - Ana M. Peiró
- Neuropharmacology on Pain Research Unit, Institute of Health and Biomedical Research of Alicante (ISABIAL-FISABIO), Alicante, Spain
- Clinical Pharmacology, HGUA, Alicante, Spain
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23
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Planelles B, Margarit C, Ajo R, Sastre Y, Muriel J, Inda MDM, Esteban MD, Peiró AM. Health benefits of an adverse events reporting system for chronic pain patients using long-term opioids. Acta Anaesthesiol Scand 2019; 63:248-258. [PMID: 30109708 DOI: 10.1111/aas.13243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 06/14/2018] [Accepted: 07/19/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Safety data from long-term opioid therapy in the real world has been poorly studied in chronic non-cancer pain (CNCP). The aim was to design a pharmacovigilance data recording system and assess whether participation in this recording system improves pain management, enhancing patient's health status. METHODS A pharmacovigilance data recording system was conducted during 24 months. Data were self-reported by patients (pain, adverse events [AEs] and healthcare resources use) and physicians (morphine equivalent daily dose [MEDD] prescribed and suspected adverse drug reaction [ADRs]). Outcomes from patients with (case) or without (controls) suspected ADRs and cases follow-up were also compared with Spanish Pharmacovigilance System data. RESULTS A total of 753 patients were recruited in 897 visits. Fentanyl and tramadol were the most prescribed opioids, 89% with concomitant drugs, pregabalin being the one with the most potential drug interactions. Cases presented significantly higher pain intensity (VAS 67 ± 26 vs 59 ± 30 mm, P < 0.05), number of AEs (8 ± 6 vs 5 ± 3 AEs/patient, P < 0.01), polypharmacy related to pain (65% vs 34%, P < 0.01) and MEDD (139 ± 130 vs 106 ± 99 mg/d, P < 0.01) than controls. Furthermore, cases presented significant higher changes in pharmacological pain therapy due to pain, unplanned emergency visits and hospital admission than controls. Physicians notified 168 suspected ADRs mostly related to neurological or psychiatric events and 8% of them were previously unknown. CONCLUSIONS This data recording system provided important information to achieve a better control of CNCP pharmacological pain therapy, improving patient's health status and reducing costs to the Health System.
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Affiliation(s)
- Beatriz Planelles
- Pain Unit; Alicante Department of Health-General Hospital; Alicante Spain
- Neuropharmacology on Pain (NED); Research Unit; Department of Health of Alicante-General Hospital; ISABIAL; Alicante Spain
| | - César Margarit
- Pain Unit; Alicante Department of Health-General Hospital; Alicante Spain
- Neuropharmacology on Pain (NED); Research Unit; Department of Health of Alicante-General Hospital; ISABIAL; Alicante Spain
| | - Raquel Ajo
- Neuropharmacology on Pain (NED); Research Unit; Department of Health of Alicante-General Hospital; ISABIAL; Alicante Spain
| | - Yolanda Sastre
- Pain Unit; Alicante Department of Health-General Hospital; Alicante Spain
| | - Javier Muriel
- Neuropharmacology on Pain (NED); Research Unit; Department of Health of Alicante-General Hospital; ISABIAL; Alicante Spain
| | - María-del-Mar Inda
- Neuropharmacology on Pain (NED); Research Unit; Department of Health of Alicante-General Hospital; ISABIAL; Alicante Spain
| | - María D. Esteban
- Operative Research Center; Miguel Hernandez University; Elche Spain
| | - Ana M. Peiró
- Pain Unit; Alicante Department of Health-General Hospital; Alicante Spain
- Neuropharmacology on Pain (NED); Research Unit; Department of Health of Alicante-General Hospital; ISABIAL; Alicante Spain
- Clinical Pharmacology Unit; Alicante Department of Health-General Hospital; Alicante Spain
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24
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Abstract
Background: The experience of chronic non-cancer pain (CNCP) is one of the most
common reasons individuals seek medical attention. Patients with CNCP frequently experience
concomitant sleep-related problems.
Objectives: The aim was to evaluate sleep problems in opioid naïve CNCP patients, before
and after opioid titration, analyzing the influence of OPRM1 gene variants.
Study Design: A prospective, cohort, observational study.
Setting: This study was performed at the Pain Unit of the Alicante University General Hospital.
Methods: Pain and Medical Outcomes Study Sleep questionnaire (MOS-Sleep) were assessed
at baseline and 3 months after opioid titration in 231 opioid naïve CNCP patients. Sleep
data was compared with a matched-control group (n = 64). Morphine equivalent daily doses,
adverse events, and drugs prescribed for pain were also registered. OPRM1 polymorphism
rs1799971 was analyzed by RT-PCR. Ethics Committee approved the study and results were
analyzed by R software.
Results: After 3 months of opioid titration, patients with CNCP (63 ± 14 years, 64% female,
VAS 74 ± 17 mm) significantly decreased pain intensity, anxiety and depression, and increased
quality of life. Sleep problems were significantly more frequent in females (P = 0.002). Age,
quality of life, anxiety, and depression all influenced sleep disturbances and problems indices,
which were significantly different from the control group. Furthermore, the OPRM1 118-
GG genotype was also associated with significantly lower sleep adequacy, and more sleep
problems.
Limitations: Total number of subjects studied was relatively small and most patients were on
other non-opioid centrally-acting medications.
Conclusions: Opioids decreased CNCP severity, improving patients’ psychological areas, and
quality of life. However, patients with OPRM1 118-GG genotype indicated an increase in sleep
problems and worsening sleep pattern while taking opioids.
Key words: OPRM1, pharmacogenetics, MOS-Sleep, opioids, chronic noncancer pain, sleep
related problems, sleep problem index SLP-6 and SLP-9
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Affiliation(s)
- Ana M Peiró
- 1 Pain Unit, Health Department of Alicante-General Hospital, Alicante, Spain; 2 Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain 5 Clinical Pharmacology Unit, Health Department of AlicanteGeneral Hospital, Alicante, Spain
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25
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Mateu M, Alda O, Inda MDM, Margarit C, Ajo R, Morales D, van-der Hofstadt CJ, Peiró AM. Randomized, Controlled, Crossover Study of Self-administered Jacobson Relaxation in Chronic, Nonspecific, Low-back Pain. Altern Ther Health Med 2018; 24:22-30. [PMID: 30982021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CONTEXT Opioids decrease pain and improve functional capacity and quality of life; however, they are not always effective and are associated with harmful side effects. Few studies have shown that relaxation-based therapies, in comparison with usual care, can decrease pain. OBJECTIVE The objective of the study was to investigate whether a controlled relaxation treatment, Jacobson progressive muscular relaxation (PMR), was effective in relieving chronic low-back pain (CLBP) and reducing pain comorbidities. The research team hypothesized that PMR-controlled relaxation could be more effective in reducing CLBP than music. DESIGN The research team designed a randomized, controlled, crossover study. SETTING The study took place in the pain unit, a clinic, in the Department of Health at Alicante-General Hospital (Alicante, Spain). PARTICIPANTS Participants in this study were 58 adults with nononcological CLBP, secondary to lumbar canal stenosis, who had been treated with opioids without any changes in the 3 mo prior to the study. INTERVENTION Participants were randomly assigned to 1 of 2 groups, each of which received 2 treatments, but in a different order (ie, either AB or BA where A was the standardized PMR, the intervention, and B was relaxing music, the control. For both groups, the 2 treatment periods were 8 wk in length, with a 1-mo washout period between them. OUTCOME MEASURES The primary outcome measures included (1) a visual analogue scale-pain and relief intensity; (2) the 12-item short form health survey-quality of life; (3) the hospital anxiety and depression scale-anxiety and depression; and (4) the medical outcomes study sleep scale-sleep disturbances. Secondary outcome measures included a self-efficacy scale and a measure of satisfaction with treatment and compliance. RESULTS Pain was mostly mild to moderate. Greater decreases in pain between baseline and postintervention were observed for the PMR vs the control treatment in the mild pain category, with a VAS difference of 1.8 cm and P = .018. Significant differences were also found in anxiety, depression, quality of life, and sleep between participants in the 3 pain categories. Self-rated adherence was high. CONCLUSIONS Findings support the efficacy and acceptability of a self-guided PMR intervention for reducing CLBP with minimal time with a therapist.
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Ballester P, Martínez MJ, Javaloyes A, Inda MDM, Fernández N, Gázquez P, Aguilar V, Pérez A, Hernández L, Richdale AL, Peiró AM. Sleep problems in adults with autism spectrum disorder and intellectual disability. Autism Res 2018; 12:66-79. [PMID: 30273974 DOI: 10.1002/aur.2000] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/22/2018] [Accepted: 06/18/2018] [Indexed: 12/11/2022]
Abstract
Sleep problems (SP) are recognized as a common comorbid condition in autism spectrum disorder (ASD) and can influence core autism symptoms and mental and physical health. SPs can be lifelong and have been reported that adults on the autistic spectrum with and without intellectual disability (ID) present SPs (longer sleep latency, frequent night awakenings, and circadian rhythm sleep-wake disorders). A prospective, objective sleep study was conducted in 41 adults with ASD (33 ± 6 years old) and ID and 51 typically developing adults (33 ± 5 years old) using ambulatory circadian monitoring (ACM) recording wrist temperature, motor activity, body position, sleep, and light intensity. The findings indicated that individuals with ASD presented sleep difficulties including low sleep efficiency, prolonged sleep latency and increased number and length of night awakenings, together with daily sedentary behavior, and increased nocturnal activity. Furthermore, indications of an advanced sleep-wake phase disorder were found in these autistic adults. Examining sleep and markers of the circadian system showed significant differences between adults with ASD and ID and an age-matched, healthy adult population. The sleep disturbances described for this sample of adults with ASD and ID are similar to those of already described for adults with ASD without ID; their relationship with intellectual ability should be further studied. Improving knowledge of sleep patterns in ASD adults with ID might help to designed targeted interventions to improve their functioning and reduce family stress. Autism Research 2019, 12: 66-79. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: SPs are very frequent in autism from childhood to adulthood. We recorded sleep with a watch-like device in adults with autism and ID and compared sleep patterns with nonautistic volunteers. Results showed poorer sleep conditions in adults with autism (increased sleep latency and number/length of night awakenings) that resulted in decreased sleep efficiency. Increasing knowledge of the SPs in adults on the autism spectrum will allow to improve their and their families' quality of life.
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Affiliation(s)
- Pura Ballester
- Department of Health of Alicante-General Hospital, ISABIAL, Neuropharmacology on Pain (NED) Research Unit, Alicante, Spain.,Department of Clinical Pharmacology, Organic Chemistry and Pediatrics, Miguel Hernández University of Elche, Alicante, Spain
| | - María José Martínez
- Chronobiology Lab, College of Biology, Department of Physiology, University of Murcia, IUIE, IMIB-Arrixaca, Murcia, Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Auxiliadora Javaloyes
- EDUCATEA, Education Center for Children and Adolescents with Autism, Mental Health Problems and Behavioral Disorders, Alicante, Spain
| | - María-Del-Mar Inda
- Department of Health of Alicante-General Hospital, ISABIAL, Neuropharmacology on Pain (NED) Research Unit, Alicante, Spain
| | | | | | | | - Agustín Pérez
- Department of Statistics and Financial Resources, Miguel Hernández University of Elche, Alicante, Spain
| | - Luís Hernández
- Sleep Unit, Department of Health of Alicante-General Hospital, ISABIAL, Alicante, Spain
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Ana M Peiró
- Department of Health of Alicante-General Hospital, ISABIAL, Neuropharmacology on Pain (NED) Research Unit, Alicante, Spain.,Department of Clinical Pharmacology, Organic Chemistry and Pediatrics, Miguel Hernández University of Elche, Alicante, Spain.,Department of Health of Alicante-General Hospital, Clinical Pharmacology, Alicante, Spain
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27
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Muriel J, Margarit C, Planelles B, Serralta MJ, Puga C, Inda MDM, Cutillas E, Morales D, Horga JF, Peiró AM. OPRM1 influence on and effectiveness of an individualized treatment plan for prescription opioid use disorder patients. Ann N Y Acad Sci 2018; 1425:82-93. [PMID: 29781244 DOI: 10.1111/nyas.13735] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 12/25/2022]
Abstract
Screening for opioid use disorder should be considered in chronic non-cancer pain (CNCP) patients with long-term use of opioids. The aim of our study was to assess the effectiveness of an individualized treatment plan (ITP) for prescription opioid dependence that included screening of pharmacogenetic markers. An observational prospective study was performed using prescription opioid-dependent CNCP outpatients (n = 88). Patients were divided into nonresponders, responders, or high responders according to their response to the ITP. Genotyping of OPRM1 (A118G), OPRD1 (T921C), COMT (G472A), ABCB1 (C3435T), and ARRB2 (C8622T) was performed by real-time PCR. Our ITP achieved a significant reduction of the morphine equivalent daily dose (MEDD) in 64% of responders, including 33% of high responders. Nonopioid medication or buprenorphine use was significantly higher at final versus basal visit. 118-AA OPRM1 patients required significantly lower MEDD at basal and final visits. Our ITP showed effectiveness and security in reducing MEDD in opioid-dependent patients, with good conversion to buprenorphine that was more pronounced in 118-AA OPRM1 patients.
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Affiliation(s)
- Javier Muriel
- Neuropharmacology on Pain (NED) Research Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante-General Hospital, Alicante, Spain.,Occupational Observatory, Miguel Hernández University of Elche, Elche, Spain
| | - César Margarit
- Neuropharmacology on Pain (NED) Research Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante-General Hospital, Alicante, Spain.,Pain Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Beatriz Planelles
- Neuropharmacology on Pain (NED) Research Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante-General Hospital, Alicante, Spain.,Pain Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - María J Serralta
- Clinical Psychology and Psychiatry Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Carmen Puga
- Neuropharmacology on Pain (NED) Research Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante-General Hospital, Alicante, Spain
| | - María-Del-Mar Inda
- Neuropharmacology on Pain (NED) Research Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante-General Hospital, Alicante, Spain
| | - Esperanza Cutillas
- Neuropharmacology on Pain (NED) Research Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante-General Hospital, Alicante, Spain.,Pain Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Domingo Morales
- Operations Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - José F Horga
- Clinical Pharmacology Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Ana M Peiró
- Neuropharmacology on Pain (NED) Research Group, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante-General Hospital, Alicante, Spain.,Pain Unit, Department of Health of Alicante-General Hospital, Alicante, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
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Abstract
Pain is an unpleasant feeling usually resulting from tissue damage that can persist along weeks, months, or even years after the injury, turning into pathological chronic pain, the leading cause of disability. Currently, pharmacology interventions are usually the first-line therapy but there is a highly variable analgesic drug response. Pharmacogenetics (PGx) offers a means to identify genetic biomarkers that can predict individual analgesic response opening doors to precision medicine. PGx analyze the way in which the presence of variations in the DNA sequence (single-nucleotide polymorphisms, SNPs) could be responsible for portions of the population reaching different levels of pain relief (phenotype) due to gene interference in the drug mechanism of action (pharmacodynamics) and/or its concentration at the place of action (pharmacokinetics). SNPs in the cytochrome P450 enzymes genes (CYP2D6) influence metabolism of codeine, tramadol, hydrocodone, oxycodone, and tricyclic antidepressants. Blood concentrations of some NSAIDs depend on CYP2C9 and/or CYP2C8 activity. Additional candidate genes encode for opioid receptors, transporters, and other molecules important for pharmacotherapy in pain management. However, PGx studies are often contradictory, slowing the uptake of this information. This is likely due, in large part, to a lack of robust evidence demonstrating clinical utility and to its polygenic response modulated by other exogenous or epigenetics factors. Novel therapies, including targeting of epigenetic changes and gene therapy-based approaches, broaden future options to improve understanding of pain and the treatment of people who suffer it.
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Affiliation(s)
- Ana M Peiró
- Clinical Pharmacology Unit, Department of Health of Alicante-General Hospital, Alicante, Spain; Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.
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Roca R, Esteban P, Zapater P, Inda MDM, Conte AL, Gómez-Escolar L, Martínez H, Horga JF, Palazon JM, Peiró AM. β2‑adrenergic receptor functionality and genotype in two different models of chronic inflammatory disease: Liver cirrhosis and osteoarthritis. Mol Med Rep 2018; 17:7987-7995. [PMID: 29620176 DOI: 10.3892/mmr.2018.8820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/28/2017] [Indexed: 11/06/2022] Open
Abstract
The present study was designed to investigate the functional status of β2 adrenoceptors (β2AR) in two models of chronic inflammatory disease: liver cirrhosis (LC) and osteoarthritis (OA). The β2AR gene contains three single nucleotide polymorphisms at amino acid positions 16, 27 and 164. The aim of the present study was to investigate the potential influence of lymphocyte β2AR receptor functionality and genotype in LC and OA patients. Blood samples from cirrhotic patients (n=52, hepatic venous pressure gradient 13±4 mmHg, CHILD 7±2 and MELD 11±4 scores), OA patients (n=30, 84% Kellgren‑Lawrence severity 4 grade, 14% knee replacement joint) and healthy volunteers as control group (n=26) were analyzed. Peripheral blood mononuclear cells (PBMC) were isolated from whole blood and basal and isoproterenol induced adenylate cyclase activity (isoproterenol stimulus from 10‑9 to 10‑4 mM), and β2AR allelic variants (rs1042713, rs1042714, rs1800888) were determined. β2AR functionality was decreased in the two different models of chronic inflammatory disease studied, OA (50% vs. control) and LC (85% vs. control). In these patients, the strength of the β2AR response to adrenergic stimulation was very limited. Adrenergic modulation of PBMC function through the β2AR stimulus is decreased in chronic inflammatory processes including LC and OA, suggesting that the adrenergic system may be important in the development of these processes.
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Affiliation(s)
- Reyes Roca
- Occupational Observatory, Miguel Hernández University (UMH) of Elche, 03202 Elche, Spain
| | - Pablo Esteban
- Occupational Observatory, Miguel Hernández University (UMH) of Elche, 03202 Elche, Spain
| | - Pedro Zapater
- CIBERehd, Carlos III Health Institute, 28029 Madrid, Spain
| | - María-Del-Mar Inda
- Neuropharmacology on Pain (NED) Research Group, ISABIAL‑FISABIO, General Hospital of Alicante, 03010 Alicante, Spain
| | - Anna Lucia Conte
- Occupational Observatory, Miguel Hernández University (UMH) of Elche, 03202 Elche, Spain
| | | | | | - José F Horga
- Clinical Pharmacology, General Hospital of Alicante, 03010 Alicante, Spain
| | - José M Palazon
- Liver Unit, General Hospital of Alicante, 03010 Alicante, Spain
| | - Ana M Peiró
- Clinical Pharmacology, General Hospital of Alicante, 03010 Alicante, Spain
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Peiró AM, Margargit C, LLerena A. Drug-drug interactions. Things to do in pain management. Drug Metab Pers Ther 2018; 33:1-2. [PMID: 29305567 DOI: 10.1515/dmpt-2017-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ana M Peiró
- Clinical Pharmacology Unit; and Neuropharmacology on Pain and Functional Diversity (NED), Department of Health of Alicante - General Hospital, ISABIAL, Alicante, Spain
| | - César Margargit
- Pain Unit, Department of Health of Alicante General Hospital, Alicante, Spain
| | - Adrián LLerena
- CICAB Clinical Research Center, Extremadura University Hospital and Medical School, Badajoz, Spain
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Peiró AM, Planelles B, Juhasz G, Bagdy G, Libert F, Eschalier A, Busserolles J, Sperlagh B, Llerena A. Pharmacogenomics in pain treatment. Drug Metab Pers Ther 2017; 31:131-42. [PMID: 27662648 DOI: 10.1515/dmpt-2016-0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/08/2016] [Indexed: 11/15/2022]
Abstract
The experience of chronic pain is one of the commonest reasons for seeking medical attention, being a major issue in clinical practice. While pain is a universal experience, only a small proportion of people who felt pain develop pain syndromes. In addition, painkillers are associated with wide inter-individual variability in the analgesic response. This may be partly explained by the presence of single nucleotide polymorphisms in genes encoding molecular entities involved in pharmacodynamics and pharmacokinetics. However, uptake of this information has been slow due in large part to the lack of robust evidences demonstrating clinical utility. Furthermore, novel therapies, including targeting of epigenetic changes and gene therapy-based approaches are further broadening future options for the treatment of chronic pain. The aim of this article is to review the evidences behind pharmacogenetics (PGx) to individualize therapy (boosting the efficacy and minimizing potential toxicity) and genes implicated in pain medicine, in two parts: (i) genetic variability with pain sensitivity and analgesic response; and (ii) pharmacological concepts applied on PGx.
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Mafé JJ, Planelles B, Asensio S, Cerezal J, Inda MDM, Lacueva J, Esteban MD, Hernández L, Martín C, Baschwitz B, Peiró AM. Cost and effectiveness of lung lobectomy by video-assisted thoracic surgery for lung cancer. J Thorac Dis 2017; 9:2534-2543. [PMID: 28932560 DOI: 10.21037/jtd.2017.07.51] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Video-assisted thoracic surgery (VATS) emerged as a minimally invasive surgery for diseases in the field of thoracic surgery. We herein reviewed our experience on thoracoscopic lobectomy for early lung cancer and evaluated Health System use. METHODS A cost-effectiveness study was performed comparing VATS vs. open thoracic surgery (OPEN) for lung cancer patients. Demographic data, tumor localization, dynamic pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV1), diffusion capacity (DLCO) and maximal oxygen uptake (VO2max)], surgical approach, postoperative details, and complications were recorded and analyzed. RESULTS One hundred seventeen patients underwent lung resection by VATS (n=42, 36%; age: 63±9 years old, 57% males) or OPEN (n=75, 64%; age: 61±11 years old, 73% males). Pulmonary function tests decreased just after surgery with a parallel increasing tendency during first 12 months. VATS group tended to recover FEV1 and FVC quicker with significantly less clinical and post-surgical complications (31% vs. 53%, P=0.015). Costs including surgery and associated hospital stay, complications and costs in the 12 months after surgery were significantly lower for VATS (P<0.05). CONCLUSIONS The VATS approach surgery allowed earlier recovery at a lower cost than OPEN with a better cost-effectiveness profile.
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Affiliation(s)
- Juan J Mafé
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Beatriz Planelles
- Neuropharmacology on Pain (NED), Research Unit, Department of Health of Alicante-General Hospital, ISABIAL, Spain
| | - Santos Asensio
- Department of Pneumology, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Jorge Cerezal
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - María-Del-Mar Inda
- Neuropharmacology on Pain (NED), Research Unit, Department of Health of Alicante-General Hospital, ISABIAL, Spain
| | - Javier Lacueva
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | | | - Luis Hernández
- Department of Pneumology, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Concepción Martín
- Department of Pneumology, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Benno Baschwitz
- Department of Thoracic Surgery, Department of Health of Alicante-General Hospital, Alicante, Spain
| | - Ana M Peiró
- Neuropharmacology on Pain (NED), Research Unit, Department of Health of Alicante-General Hospital, ISABIAL, Spain.,Clinical Pharmacology Unit, Department of Health of Alicante-General Hospital, Alicante, Spain
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Ajo R, Segura A, Mira L, Inda MDM, Alfayate R, Sánchez-Barbie A, Margarit C, Peiró AM. The relationship of salivary testosterone and male sexual dysfunction in opioid-associated androgen deficiency (OPIAD). Aging Male 2017; 20:1-8. [PMID: 27750480 DOI: 10.1080/13685538.2016.1185408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Opioids are an effective treatment for chronic non-malignant pain (CNP). Long-term use risks and side effects such as opioid-induced androgen deficiency (OPIAD) exist. This could be measured by saliva testosterone (Sal-T). OBJECTIVES To evaluate OPIAD in long-term opioid use in CNP patients. METHODS A cross-sectional study included CNP male outpatients under opioid treatment. Total-Testosterone (Total-T), Free-Testosterone (Free-T), Bio-Testosterone (Bio-T) and Sal-T were measured. Correlations were calculated by Spearman's rho (SPSS 20). RESULTS From 2012 to 2014, 134 from 249 (54%) consecutive male outpatients reported erectile dysfunction (ED), 37% of them related to opioids and 19% evidenced OPIAD. A total of 120 subjects (94 cases and 26 matched-controls) were included. A significantly lower luteinizing hormone, Total-T and Free-T were found, as well as, a significant correlation between Sal-T and Total-T (r = 0.234, p = 0.039), Bio-T (r = 0.241, p = 0.039), IIEF (r = 0.363, p = 0.003) and HAD-anxiety (r = -0.414, p = 0.012) in OPIAD patients. Sal-T levels were significantly lower in patients with severe-moderate ED versus mild ED (p = 0.045) and in patients with severe ED versus moderate-mild ED (p = 0.036). CONCLUSIONS These data demonstrate the high prevalence of ED in long-term use of opioids, part of this is associated to OPIAD, which can be tested by Sal-T as a non-invasive approach.
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Affiliation(s)
- Raquel Ajo
- a Research Unit, Foundation for the Promotion of Health Research and Biomedicine of Valencia (FISABIO) , Alicante , Spain
| | - Ana Segura
- b Andrology Unit, University General Hospital of Alicante (HGUA) , Alicante , Spain
| | - Laura Mira
- c Occupational Observatory, University Miguel Hernández of Elche (UMH) , Alicante , Spain
| | - María-Del-Mar Inda
- a Research Unit, Foundation for the Promotion of Health Research and Biomedicine of Valencia (FISABIO) , Alicante , Spain
| | | | | | | | - Ana M Peiró
- a Research Unit, Foundation for the Promotion of Health Research and Biomedicine of Valencia (FISABIO) , Alicante , Spain
- g Clinical Pharmacology, HGUA , Alicante , Spain
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Ajo R, Segura A, Inda MDM, Margarit C, Ballester P, Martínez E, Ferrández G, Sánchez-Barbie Á, Peiró AM. Erectile dysfunction in patients with chronic pain treated with opioids. Med Clin (Barc) 2017; 149:49-54. [PMID: 28236471 DOI: 10.1016/j.medcli.2016.12.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVE Chronic pain is associated with comorbidities that have an impact on the quality of life of patients and, among others, affect their sexual functioning. One of the most relevant side effects of opioid analgesics is erectile dysfunction (ED), due in part to the inhibition of the gonadal-pituitary-hypothalamic axis and the decline in testosterone levels. To evaluate ED and effectiveness of treatment in men with chronic pain treated with long-term opioids. MATERIAL AND METHODS Prospective observational study lasting 3 years, where the intensity of pain (visual analogue scale, 0-10cm), erectile function (IIEF-EF, range 1-30 points), quality of life (EQ-VAS, 0-100mm), quality of sexual life (MSLQ-QOL, 0-100 points), anxiety/depression (HAD, 0-21 points) and testosterone levels, was assessed in patients who reported sexual dysfunction (ED or libido modification). A 6-month follow-up was applied to each patient after administering the usual treatment in the Andrology Unit. The study was approved by the Clinical Research Ethics Committee and data were statistically analyzed with the GraphPad Prism 5 software. RESULTS ED was observed in 27.6% of patients (n=105, 57±12.2 years, mean dose of morphine equivalent=107.1±107.9mg/day, 84.3% adjuvant analgesics). After 6 months, 42% of patients showed a significant improvement after being treated with iPDE5 (48.5%) and/or testosterone gel (81.8%), with a resolution rate of 31% (p=0.000). A positive correlation was observed between the improvement of IIEF and quality of sexual life (55.5±25.7 points, p=0.000), as well as anxiety (7.4±4.3 points, p=0.048). No significant changes were observed in the levels of testosterone, in the levels of pain nor in the quality of life, which remained moderate. CONCLUSIONS Erectile function and quality of sexual life, as well as anxiety, improved in patients treated chronically with opioids after administering andrological treatment. The management of patients with pain should include a review of their sexual health history given the significant emotional impact posed to the patient, the impact on their overall quality of life and its good clinical response to an interdisciplinary treatment.
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Affiliation(s)
- Raquel Ajo
- Unidad de Investigación, Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España
| | - Ana Segura
- Unidad de Andrología, Hospital General Universitario de Alicante (HGUA), Alicante, España; Grupo Neurofarmacología aplicada al dolor y diversidad funcional (NED), Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España
| | - María-Del-Mar Inda
- Unidad de Investigación, Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España; Grupo Neurofarmacología aplicada al dolor y diversidad funcional (NED), Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España
| | - César Margarit
- Grupo Neurofarmacología aplicada al dolor y diversidad funcional (NED), Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España; Unidad de Dolor (UDO), Hospital General Universitario de Alicante (HGUA), Alicante, España
| | - Pura Ballester
- Unidad de Investigación, Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España; Grupo Neurofarmacología aplicada al dolor y diversidad funcional (NED), Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España
| | - Emi Martínez
- Observatorio Ocupacional, Universidad Miguel Hernández (UMH), Elche, España
| | - Guillermina Ferrández
- Unidad de Andrología, Hospital General Universitario de Alicante (HGUA), Alicante, España
| | - Ángel Sánchez-Barbie
- Centro de Investigación Operacional (CIO), Universidad Miguel Hernández (UMH), Elche, España
| | - Ana M Peiró
- Grupo Neurofarmacología aplicada al dolor y diversidad funcional (NED), Hospital General Universitario de Alicante (HGUA), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España; Unidad de Farmacología Clínica, Hospital General Universitario de Alicante (HGUA), Alicante, España.
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Affiliation(s)
- Ana M Peiró
- Clinical Pharmacology Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
- Neuropharmacology on Pain & Functional Diversity (NED), Research Unit, Department of Health of Alicante, General Hospital, ISABIAL, Alicante, Spain
| | - César Margarit
- Neuropharmacology on Pain & Functional Diversity (NED), Research Unit, Department of Health of Alicante, General Hospital, ISABIAL, Alicante, Spain
- Pain Unit, Department of Health of Alicante, General Hospital, Alicante, Spain
| | - Adrián LLerena
- CICAB Clinical Research Centre, Extremadura University Hospital & Medical School, Badajoz, Spain
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36
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Peiró AM, Tang CM, Murray F, Zhang L, Brown LM, Chou D, Rassenti L, Kipps TJ, Insel PA. Erratum: Genetic variation in phosphodiesterase (PDE) 7B in chronic lymphocytic leukemia: overview of genetic variants of cyclic nucleotide PDEs in human disease. J Hum Genet 2013. [DOI: 10.1038/jhg.2013.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Peiró AM, Farré M, Roset PN, Carbó M, Pujadas M, Torrens M, Camí J, de la Torre R. Human pharmacology of 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) after repeated doses taken 2 h apart. Psychopharmacology (Berl) 2013; 225:883-93. [PMID: 23142957 DOI: 10.1007/s00213-012-2894-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 09/03/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) is one of the most abused recreational drugs. Its usual pattern of misuse includes repeated doses taken over a short time period that could influence MDMA pharmacology and toxicity. OBJECTIVE This study aims to evaluate the pharmacokinetics and pharmacologically induced effects of two MDMA consecutive doses separated by 2 h. METHODS A randomized, double-blind, crossover, and placebo-controlled trial included ten male volunteers participating in two experimental sessions. MDMA was administered as a single 100-mg dose or as a repeated dose (50 mg followed by 100 mg, administered at 2 h apart). Outcome variables included pharmacokinetics, physiological, subjective, and psychomotor effects. RESULTS Following the repeated doses, plasma concentrations of MDMA were higher than those expected by simple dose accumulation (+16.2 % AUC; +12.8 % C (max)), but those of HMMA and HMA were significantly lower (-29.8 % AUC; -38.2 % C (max)). After the second dose, physiological effects, psychomotor performance, and subjective effects were lower than expected especially for euphoria and stimulation. MDMA-induced increases in diastolic and systolic arterial pressure and body temperature were in the range of those expected following MDMA concentrations. CONCLUSIONS MDMA pharmacokinetics and metabolic disposition following two doses separated by 2 h show that the contribution of the first dose to the MDMA-induced mechanism-based metabolic inhibition was already apparent. The concentrations of MDMA after the second dose were slightly higher than expected. The effects on blood pressure and temperature after the second administration were slightly higher than those following the first, but for heart rate and subjective variables these were lower than expected considering the MDMA concentrations achieved, suggesting a possible tolerance phenomenon.
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Affiliation(s)
- A M Peiró
- Human Pharmacology and Clinical Neurosciences Research Group, Neurosciences Research Programme, IMIM-Hospital del Mar Medical Research Institute, Doctor Aiguader 88, 08003 Barcelona, Spain
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Peiró AM, Tang CM, Murray F, Zhang L, Brown LM, Chou D, Rassenti L, Kipps TJ, Kipps TA, Insel PA. Genetic variation in phosphodiesterase (PDE) 7B in chronic lymphocytic leukemia: overview of genetic variants of cyclic nucleotide PDEs in human disease. J Hum Genet 2011; 56:676-81. [PMID: 21796143 DOI: 10.1038/jhg.2011.80] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Expression of cyclic adenosine monophosphate-specific phosphodiesterase 7B (PDE7B) mRNA is increased in patients with chronic lymphocytic leukemia (CLL), thus suggesting that variation may occur in the PDE7B gene in CLL. As genetic variation in other PDE family members has been shown to associate with numerous clinical disorders (reviewed in this manuscript), we sought to identify single-nucleotide polymorphisms (SNPs) in the PDE7B gene promoter and coding region of 93 control subjects and 154 CLL patients. We found that the PDE7B gene has a 5' non-coding region SNP -347C>T that occurs with similar frequency in CLL patients (1.9%) and controls (2.7%). Tested in vitro, -347C>T has less promoter activity than a wild-type construct. The low frequency of this 5' untranslated region variant indicates that it does not explain the higher PDE7B expression in patients with CLL but it has the potential to influence other settings that involve a role for PDE7B.
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Affiliation(s)
- Ana M Peiró
- Department of Pharmacology, University of California, San Diego, La Jolla, CA 92093-0636, USA
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Llanos L, Moreu R, Ortin T, Peiró AM, Pascual S, Bellot P, Barquero C, Francés R, Such J, Pérez-Mateo M, Horga JF, Zapater P. The existence of a relationship between increased serum alanine aminotransferase levels detected in premarketing clinical trials and postmarketing published hepatotoxicity case reports. Aliment Pharmacol Ther 2010; 31:1337-45. [PMID: 20331578 DOI: 10.1111/j.1365-2036.2010.04298.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Drug-induced liver injury (DILI) profile in most drugs' available information is based on both the incidence of alanine aminotansferase (ALT) elevations in clinical trials and published case reports. AIM To assess the relationship between ALT elevations in clinical trials and the number of published case reports in the postmarketing setting. METHODS Hepatotoxic drugs were identified from product labelling and classified in high-medium risk (Black Box Warning or Precautions section) or low risk (a statement in the Adverse Reactions section). Incidence of ALT elevations (> or = 3 x ULN) for drug (I(D)) and placebo (I(C)) treated patients in premarketing clinical trials and DILI published case reports were retrieved from product labelling and MEDLINE. RESULTS The median I(C) was 10/1000. The high-medium-risk drugs' median I(D) was significantly higher compared with low-risk drugs (17/1000 vs. 10/1000; P = 0.046). Chi-squared test, absolute difference and odds ratio comparing I(D) and I(C) identified 35%, 51% and 77% of high-medium-risk drugs respectively. Less number of case reports were associated with low- than high-medium-risk drugs (1 vs. 7; P = 0.001). A high odds ratio in clinical trials (I(D) vs. I(C)) was the strongest predictor of published DILI case reports. CONCLUSION A relationship between increased ALT incidence in premarketing clinical trials and postmarketing published case reports exists.
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Affiliation(s)
- L Llanos
- Clinical Pharmacology Section, Hospital General Universitario, Alicante, Spain
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Peiró AM, Margarit C, Giménez P, Horga JF. Pharmacogenetic testing is of limited utility for predicting analgesic response to morphine. J Pain Symptom Manage 2010; 39:e8-e11. [PMID: 19875268 DOI: 10.1016/j.jpainsymman.2009.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 08/06/2009] [Accepted: 08/07/2009] [Indexed: 11/20/2022]
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Llanos L, Moreu R, Peiró AM, Pascual S, Francés R, Such J, Horga JF, Pérez-Mateo M, Zapater P. Causality assessment of liver injury after chronic oral amiodarone intake. Pharmacoepidemiol Drug Saf 2009; 18:291-300. [PMID: 19165760 DOI: 10.1002/pds.1709] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM The number of patients receiving amiodarone will increase in future years. As clinically significant hepatotoxicity associated with oral amiodarone is infrequent and difficult to predict, a new Bayesian-developed model is proposed to help in the causality assessment of amiodarone-induced liver injury. METHODS Incidence of abnormal liver enzymes in patients receiving amiodarone was obtained from placebo controlled clinical trials. Published case reports of amiodarone-induced hepatotoxicity were identified through a literature search. Maximum number of expected hepatotoxicity cases in amiodarone and placebo-treated patients was calculated using Poisson distribution. The calculated odds ratio was used as a Prior Odds (PrO) to subsequent quantification, using a Bayesian-approach, of individual amiodarone-induced hepatotoxicity likelihood. RESULTS PrO of amiodarone-induced hepatotoxicity was 0.48. Thirty nine amiodarone-associated hepatotoxicity case reports were retrieved. Half of published case reports developed an irreversible damage. The amiodarone Bayesian model combining information about latency period and period of remission, together with analytical parameters properly defines the toxicity profile shown in published case reports. The analytical pattern defined by this model is different from the one expected if liver injury in published cases was caused by other etiologies. CONCLUSIONS A method based on a Bayesian-approach, which links information from clinical trials with clinical hepatotoxicity profile from published case reports can be a useful tool for amiodarone-induced liver injury causality assessment. At present, this method is limited due to scarcity and quality of available data. Further efforts are needed to improve model ability in order to identify amiodarone-induced liver injury.
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Affiliation(s)
- Lucía Llanos
- Clinical Pharmacology Section, University General Hospital, Alicante, Spain.
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Peiró AM. Respuesta de los autores. Med Clin (Barc) 2009. [DOI: 10.1016/j.medcli.2008.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Peiró AM. [Bioethics and the legal acting basis upon a Jehova's witness patient's who refuse to receive a blood transfusion]. Med Clin (Barc) 2008; 130:558-9. [PMID: 18457626 DOI: 10.1157/13119718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Peiró AM, Martínez J, Martínez E, de Madaria E, Llorens P, Horga JF, Pérez-Mateo M. Efficacy and tolerance of metamizole versus morphine for acute pancreatitis pain. Pancreatology 2008; 8:25-9. [PMID: 18235213 DOI: 10.1159/000114852] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 08/10/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Morphine has been contraindicated for pain treatment in acute pancreatitis because of its presumed opioid-induced sphincter of Oddi dysfunction. However, scientific evidence supporting a deleterious influence on the clinical course is absent. This pilot study was undertaken to evaluate the efficacy and adverse events of metamizole versus morphine in acute pancreatitis. METHODS 16 patients with acute pancreatitis were randomized to receive 10 mg/4 h s.c. (n = 8) morphine or 2 g/8 h i.v. (n = 8) metamizole. Pain scores were recorded every 4 h during 48 h after admission by a Visual Analogue Scale. Pethidine was additionally administered as a rescue therapy. RESULTS 75% of patients achieved pain relief in the metamizole group versus 37.5% in the morphine group within 24 h of hospitalization (6/8 vs. 3/8; p: n.s.). The mean time to achieve pain relief was shorter in the metamizole group (10 +/- 6.6 vs. 17 +/- 18.3 h; p: n.s.). At the end of the study, 75% of patients achieved pain relief in the metamizole group versus 50% in the morphine group. Three patients in each group needed pethidine: 2 out of 3 achieved pain control in the metamizole group vs. 0 out of 3 in the morphine group. CONCLUSIONS Intravenous metamizole shows a non-significant association with a quicker pain relief than morphine s.c. in acute pancreatitis. A larger randomized controlled trial should be desirable to confirm this result. and IAP.
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Affiliation(s)
- A M Peiró
- Clinical Pharmacology Unit, Hospital General Universitario de Alicante, Alicante, Spain
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Peiró AM, Zapater P, Alenda C, Ramírez A, Gutiérrez A, Pérez-Mateo M, Such J. Hepatotoxicity related to paraquat and diquat absorption through intact skin. Dig Dis Sci 2007; 52:3282-4. [PMID: 17909977 DOI: 10.1007/s10620-005-9056-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 09/20/2005] [Indexed: 12/09/2022]
Affiliation(s)
- Ana M Peiró
- Clinical Pharmacology Unit, Hospital General de Alicante, Pintor Baeza, s/n, 03010, Alicante, Spain.
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Farré M, Abanades S, Roset PN, Peiró AM, Torrens M, O'Mathúna B, Segura M, de la Torre R. Pharmacological interaction between 3,4-methylenedioxymethamphetamine (ecstasy) and paroxetine: pharmacological effects and pharmacokinetics. J Pharmacol Exp Ther 2007; 323:954-62. [PMID: 17890444 DOI: 10.1124/jpet.107.129056] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") is increasingly used by young people for its euphoric and empathic effects. MDMA can be used in combination with other drugs such as selective serotonin reuptake inhibitors. A clinical trial was designed where subjects pretreated with paroxetine, one of the most potent inhibitors of both 5-hydroxytryptamine reuptake and CYP2D6 activity, were challenged with a single dose of MDMA. The aim of the study was to evaluate the pharmacodynamic and pharmacokinetic interaction between paroxetine and MDMA in humans. A randomized, double-blind, crossover, placebo-controlled trial was conducted in 12 healthy male subjects. Variables included physiological parameters, psychomotor performance, subjective effects, and pharmacokinetics. Subjects received 20 mg/day paroxetine (or placebo) orally for the 3 days before MDMA challenge (100 mg oral). MDMA alone produced the prototypical effects of the drug. Pretreatment with paroxetine was associated with marked decreases of both physiological and subjective effects of MDMA, despite a 30% increase in MDMA plasma concentrations. The decreases of 3-methoxy-4-hydroxymethamphetamine plasma concentrations suggest a metabolic interaction of paroxetine and MDMA. These data show that pretreatment with paroxetine significantly attenuates MDMA-related physiological and psychological effects. It seems that paroxetine could interact with MDMA at pharmacodynamic (serotonin transporter) and pharmacokinetic (CYP2D6 metabolism) levels. Marked decrease in the effects of MDMA could lead users to take higher doses of MDMA and to produce potential life-threatening toxic effects.
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Affiliation(s)
- Magí Farré
- Pharmacology Research Unit, Institut Municipal d'Investigació Mèdica (Hospital del Mar), Doctor Aiguader 88, E-08003 Barcelona, Spain.
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Ravirajan P, Peiró AM, Nazeeruddin MK, Graetzel M, Bradley DDC, Durrant JR, Nelson J. Hybrid polymer/zinc oxide photovoltaic devices with vertically oriented ZnO nanorods and an amphiphilic molecular interface layer. J Phys Chem B 2007; 110:7635-9. [PMID: 16610853 DOI: 10.1021/jp0571372] [Citation(s) in RCA: 486] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report on the effect of nanoparticle morphology and interfacial modification on the performance of hybrid polymer/zinc oxide photovoltaic devices. We compare structures consisting of poly-3-hexylthiophene (P3HT) polymer in contact with three different types of ZnO layer: a flat ZnO backing layer alone; vertically aligned ZnO nanorods on a ZnO backing layer; and ZnO nanoparticles on a ZnO backing layer. We use scanning electron microscopy, steady state and transient absorption spectroscopies, and photovoltaic device measurements to study the morphology, charge separation, recombination behavior and device performance of the three types of structures. We find that charge recombination in the structures containing vertically aligned ZnO nanorods is remarkably slow, with a half-life of several milliseconds, over 2 orders of magnitude slower than that for randomly oriented ZnO nanoparticles. A photovoltaic device based on the nanorod structure that has been treated with an amphiphilic dye before deposition of the P3HT polymer yields a power conversion efficiency over four times greater than that for a similar device based on the nanoparticle structure. The best ZnO nanorod:P3HT device yields a short circuit current density of 2 mAcm(-2) under AM1.5 illumination (100 mW cm(-2)) and a peak external quantum efficiency over 14%, resulting in a power conversion efficiency of 0.20%.
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Affiliation(s)
- Punniamoorthy Ravirajan
- Department of Physics, Imperial College London, Prince Consort Road, London SW7 2BW, United Kingdom
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Affiliation(s)
- A M Peiró
- Clinical Pharmacology Unit, Hospital General de Alicante, c/Pintor Baeza s/n, 03010, Alicante, Spain.
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