Predictive Pharmacology and Pharmacogenetics Applied to Pain Medicine. Precision Pharmacology and Pharmacogenetics Applied to Pain Medicine

Approach to precision medicine based on genetics

The medical and scientific community, as well as companies and/or institutions wishing to access this knowledge, expertise and know-how, are offered support in the design and identification of genetic polymorphisms associated with response to pharmacological treatments, as an approach to precision medicine.

Predefined panels of gene polymorphisms associated with pharmacokinetics (metabolism and transport) and pharmacodynamics are currently available for the area of opioid analgesics and psychotropic medicines. These include polymorphisms ranging from those at the research stage to those that are well established and included in the product information of medicines.

However, advice is also offered on the design of customised panels of polymorphisms/genes for the development of research studies: prospective, retrospective; by pathology, gene or drug; or at the level of translational research.

Pharmacogenetic reports are provided containing the results of the analyses, together with an interpretation of their biological significance. Clinical recommendations are also provided based on the scientific evidence currently available.

Prediction of problematic medicine use

Identification of risk factors (age, sex, employment/economic situation, drug interactions, comorbidities, genetic markers, among others) that may help prevent the occurrence of adverse events in the field of pain and other areas of medicine.

A risk prediction model for dependence on opioid analgesics is currently available. It was developed retrospectively and prospectively validated, and includes sociodemographic, clinical and genetic risk factors.

Pharmacogenetic studies are recommended by the Spanish Agency for Medicines and Medical Devices (AEMPS) for certain medicines, particularly in the field of oncology. In many other fields, pharmacogenetics is still at the implementation stage based on the available scientific evidence and the cost-benefit balance, which is becoming increasingly favourable. Although numerous options for genetic panels may be available at different research or healthcare centres, our group has a specific gene panel applied to pain medicine, as well as the capacity to support the design of pharmacogenetic panels for other fields, diseases, medicines or genes of interest.

With regard to the safe use of opioid analgesics, numerous models for predicting the development of opioid dependence have been developed in recent years. However, to date, the vast majority of these studies and proposed scales have been conducted in the United States, where the situation, consumption and patterns of opioid use differ significantly from those in our European context. Proposals developed before 2015 were based on dependence criteria that have since been updated in the new version of the DSM-5. Furthermore, many are not specific to patients with chronic non-cancer pain and/or provide information on patient risk at the time opioid treatment is initiated, rather than when use has already become prolonged (>6 months). At the same time, based on the scientific evidence, including that produced by our group, the implementation of pharmacogenetic markers in these tools for predicting opioid dependence is considered relevant, as these markers have not previously been included in the existing prediction models.

Ready for immediate application. The group has an established track record of scientific publications and prospectively validated results in real patients. The offering ranges from translational research to consultancy for implementation in routine clinical practice.

• Hospitals and Pain Units: For the selection of the optimal analgesic and a safe dose.
• Pharmaceutical Industry: Design of clinical trials with patients stratified according to genetic profile.
• Health Insurance Companies: Implementation of dependence prevention programmes and cost optimisation.
• Biomedical Research Centres: Development of applied pharmacogenetics studies.

Javier Muriel Serrano – Department of Pharmacology and Organic Chemistry