Moving Away from One-Size-Fits-All: Assessing the Use of Pharmacogenetic-Guided Medication Therapy in Pediatric Patients with Chronic Pain
<b>Background/Objectives:</b> Pharmacogenetic (PGx) testing can predict drug efficacy, toxicity, and risk of adverse drug reactions (ADRs). However, PGx-guided prescribing for pediatric chronic pain is underutilized. <b>Methods</b>: We evaluated the rate of deviance from stan...
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MDPI AG
2025-05-01
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| Series: | Children |
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| author | Danielle Ruskin Klaudia Szczech Sierra Scodellaro Naiyi Sun Iris Cohn |
| author_facet | Danielle Ruskin Klaudia Szczech Sierra Scodellaro Naiyi Sun Iris Cohn |
| author_sort | Danielle Ruskin |
| collection | DOAJ |
| description | <b>Background/Objectives:</b> Pharmacogenetic (PGx) testing can predict drug efficacy, toxicity, and risk of adverse drug reactions (ADRs). However, PGx-guided prescribing for pediatric chronic pain is underutilized. <b>Methods</b>: We evaluated the rate of deviance from standard drug dosing regimens in children and adolescents with chronic pain based on PGx testing of drug-metabolizing genes. We also assessed the acceptability and feasibility of PGx testing and implementation of PGx-guided recommendations from patient, caregiver, and prescriber perspectives. Finally, we explored whether PGx results could predict self-reported therapeutic responses and/or ADRs to medications. <b>Results</b>: Forty-eight participants aged 8–17 years with chronic pain provided DNA via buccal swab. Genetic variant data for <i>CYP2D6</i>, <i>CYP2C9</i>, and <i>CYP2C19</i> metabolism genes and associated metabolizer status were analyzed with respect to clinical PGx guidelines for dosing recommendations of analgesics and psychotropic medications. Participants, their caregivers, and their prescribers also completed quantitative questionnaires evaluating their experience with PGx testing. Twenty-three (50%) participants were predicted to benefit from non-standard dosing for medications with clinical PGx guidelines. Participants expressed satisfaction with the PGx testing process and felt it was safe and worthwhile. Prescribers also reported that PGx results were relevant for medication choices in 42 (91%) participants. Seven (15%) participants had genotyping results which may have predicted their self-reported therapeutic responses and/or ADRs to specific medications. <b>Conclusions</b>: Though further research on pharmacodynamic associations is required to sufficiently address the complexity of interpatient responses to medications for the treatment of pediatric pain and mental health conditions, PGx testing may be used to inform individualized medication choices based on genetic make-up. |
| format | Article |
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| institution | OA Journals |
| issn | 2227-9067 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | MDPI AG |
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| series | Children |
| spelling | doaj-art-ff894e270f6b416c8b1c5495d0059d5c2025-08-20T02:24:34ZengMDPI AGChildren2227-90672025-05-0112672110.3390/children12060721Moving Away from One-Size-Fits-All: Assessing the Use of Pharmacogenetic-Guided Medication Therapy in Pediatric Patients with Chronic PainDanielle Ruskin0Klaudia Szczech1Sierra Scodellaro2Naiyi Sun3Iris Cohn4Department of Psychology, The Hospital for Sick Children, Toronto, ON M5G 1X8, CanadaDepartment of Psychology, The Hospital for Sick Children, Toronto, ON M5G 1X8, CanadaDivision of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, ON M5G 1X8, CanadaDepartment of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, CanadaDivision of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada<b>Background/Objectives:</b> Pharmacogenetic (PGx) testing can predict drug efficacy, toxicity, and risk of adverse drug reactions (ADRs). However, PGx-guided prescribing for pediatric chronic pain is underutilized. <b>Methods</b>: We evaluated the rate of deviance from standard drug dosing regimens in children and adolescents with chronic pain based on PGx testing of drug-metabolizing genes. We also assessed the acceptability and feasibility of PGx testing and implementation of PGx-guided recommendations from patient, caregiver, and prescriber perspectives. Finally, we explored whether PGx results could predict self-reported therapeutic responses and/or ADRs to medications. <b>Results</b>: Forty-eight participants aged 8–17 years with chronic pain provided DNA via buccal swab. Genetic variant data for <i>CYP2D6</i>, <i>CYP2C9</i>, and <i>CYP2C19</i> metabolism genes and associated metabolizer status were analyzed with respect to clinical PGx guidelines for dosing recommendations of analgesics and psychotropic medications. Participants, their caregivers, and their prescribers also completed quantitative questionnaires evaluating their experience with PGx testing. Twenty-three (50%) participants were predicted to benefit from non-standard dosing for medications with clinical PGx guidelines. Participants expressed satisfaction with the PGx testing process and felt it was safe and worthwhile. Prescribers also reported that PGx results were relevant for medication choices in 42 (91%) participants. Seven (15%) participants had genotyping results which may have predicted their self-reported therapeutic responses and/or ADRs to specific medications. <b>Conclusions</b>: Though further research on pharmacodynamic associations is required to sufficiently address the complexity of interpatient responses to medications for the treatment of pediatric pain and mental health conditions, PGx testing may be used to inform individualized medication choices based on genetic make-up.https://www.mdpi.com/2227-9067/12/6/721pediatric chronic painchronic pain servicepharmacogenetics (PGx)precision medicinequalitative analysis |
| spellingShingle | Danielle Ruskin Klaudia Szczech Sierra Scodellaro Naiyi Sun Iris Cohn Moving Away from One-Size-Fits-All: Assessing the Use of Pharmacogenetic-Guided Medication Therapy in Pediatric Patients with Chronic Pain Children pediatric chronic pain chronic pain service pharmacogenetics (PGx) precision medicine qualitative analysis |
| title | Moving Away from One-Size-Fits-All: Assessing the Use of Pharmacogenetic-Guided Medication Therapy in Pediatric Patients with Chronic Pain |
| title_full | Moving Away from One-Size-Fits-All: Assessing the Use of Pharmacogenetic-Guided Medication Therapy in Pediatric Patients with Chronic Pain |
| title_fullStr | Moving Away from One-Size-Fits-All: Assessing the Use of Pharmacogenetic-Guided Medication Therapy in Pediatric Patients with Chronic Pain |
| title_full_unstemmed | Moving Away from One-Size-Fits-All: Assessing the Use of Pharmacogenetic-Guided Medication Therapy in Pediatric Patients with Chronic Pain |
| title_short | Moving Away from One-Size-Fits-All: Assessing the Use of Pharmacogenetic-Guided Medication Therapy in Pediatric Patients with Chronic Pain |
| title_sort | moving away from one size fits all assessing the use of pharmacogenetic guided medication therapy in pediatric patients with chronic pain |
| topic | pediatric chronic pain chronic pain service pharmacogenetics (PGx) precision medicine qualitative analysis |
| url | https://www.mdpi.com/2227-9067/12/6/721 |
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