PRECISE: Pharmacogenetic-guided Choice of Post-surgery Analgesics
Study Details
Study Description
Brief Summary
Pharmacogenomics (PGx) is the study of how genes affect a person's response to drugs. PGx testing for certain genes can help predict the risk of side effects or therapeutic failure from analgesics. Testing is not regularly performed in clinical practice due to long wait times for results and challenges with integrating test results in the electronic health record. Investigators leading this study hope to find out if providing surgeons with the ability to order a PGx test and electronically receive results with dosing recommendations will increase the use of these tests to guide analgesic choice and improve patient outcomes.
This is a prospective, two-arm randomized implementation study. Eligible participants will be randomly assigned to receive genotype-guided analgesic selection (intervention arm) or usual care (control arm). Both cohorts will undergo pharmacogenetic testing at the time of consenting. The investigators will primarily measure the feasibility of using this test to guide analgesic selection.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: PGx-guided Pharmacogenetic testing using a 16 gene panel with a pharmacist consult providing genotype-guided recommendations for post-surgery analgesic selection based on CYP2D6 and CYP2C9 results. Pharmacist recommendations for all 16 gene results will also be provided in a detailed note. |
Other: Pharmacogenetic testing
Genetic testing of CYP2B6, CYP2C19, CYP2C9, CYP2C cluster CYP2D6, CYP3A5, CYP4F2, DPYD, HLA-A, HLA-B, IFNL4, NUDT15, SLCO1B1, TPMT, UGT1A1, and VKORC1.
Other: Pharmacist note with genotype-guided analgesic recommendations
CYP2C9 normal metabolizers will be recommended to receive ibuprofen and intermediate and poor metabolizers will be recommended to receive naproxen.
CYP2D6 normal metabolizers will be recommended to receive tramadol and ultrarapid, intermediate and poor metabolizers will be recommended to receive oxycodone.
Other: Pharmacist detailed note with genotype-guided recommendations per CPIC guidelines
Genotype-guided recommendations for all actionable phenotypes resulted from the 16-gene PGx panel per CPIC guidelines
|
| Other: Usual care Pharmacogenetic testing using a 16 gene panel. Post-surgery analgesic selection will be based on usual care (not the PGx results). Pharmacist recommendations for all 16 gene results will be provided in a detailed note with a delayed return of results (30 days post surgery) |
Other: Pharmacogenetic testing
Genetic testing of CYP2B6, CYP2C19, CYP2C9, CYP2C cluster CYP2D6, CYP3A5, CYP4F2, DPYD, HLA-A, HLA-B, IFNL4, NUDT15, SLCO1B1, TPMT, UGT1A1, and VKORC1.
Other: Pharmacist detailed note with genotype-guided recommendations per CPIC guidelines
Genotype-guided recommendations for all actionable phenotypes resulted from the 16-gene PGx panel per CPIC guidelines
|
Outcome Measures
Primary Outcome Measures
- Feasibility of integrating a PGx panel test in the EMR with a pharmacist consult note for each patient [14 days]
The proportion of PGx test results and pharmacist consult notes returned prior to surgery
- Fidelity to genotype-guided pharmacotherapy recommendations [14 days]
The proportion of medication selections made in agreement with the genotype-guided dosing recommendations for analgesic medications.
Secondary Outcome Measures
- Acute pain - Self-reported numeric pain score [14 days]
Mean patient Promis self-reported numeric pain scores (scale: 0-10, 0 = no pain; 10= worst pain imaginable) assessed on POD 0, 3, 7, 14 in variant carriers in the PGx-guided group vs. the control group
- Total opioid consumption in morphine milligram equivalents (MME) [14 days]
Difference in total MME consumption in variant carriers in PGx-guided group vs. control group
Eligibility Criteria
Criteria
Inclusion Criteria:
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Able and willing to provide informed consent
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Female aged 18 years or older at the time of study initiation
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Major gynecologic surgery indicated and planned for hysterectomy, myomectomy, exploratory laparotomy, and open abdominal surgery
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Willing to provide a buccal swab for PGx testing and comply with all study-related procedures
Exclusion Criteria:
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Receiving chronic opioid therapy defined as ≥ 3 consecutive months of 1-month prescriptions for an opioid
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Pregnancy
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Breastfeeding
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Treating physician does not want subject to participate
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Pennsylvania | Philadelphia | Pennsylvania | United States | 19104 |
Sponsors and Collaborators
- University of Pennsylvania
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 851447