Pharmacogenomics biomarkers for personalized methadone maintenance treatment

Introduction

Methadone is the main replacement therapy for opioid addiction. However, due to a wide inter-individual variability, the effect of methadone may be different between individuals. This means the same dose given to two different persons of the same age and sex, for example, may produce different effects. One may be able to control the opioid addiction while another person might develop withdrawal symptoms due to insufficient dose. Furthermore, the person may develop signs of overdose, even though the same dose was given. Both withdrawal and overdose are the challenges in the methadone treatment as the former may promote drug-seeking behavior, and the latter may place the patient in danger. It is important to determine factors that can be used to predict treatment outcome, so that, we can avoid the unwanted treatment effects.

The article published in the journal BJBMS aimed to demonstrate the use of genetic markers involved in methadone distribution and metabolism in the body for the prediction of the treatment outcome.

What did the research show?

In this review, the relevant data from various studies were collected and grouped according to the genetic markers involved in methadone absorption, distribution, metabolism, and elimination. The potential genetic marker involved in methadone absorption, distribution, and elimination is gene encoding the ABCB1. The genetic variation of ABCB1 in Caucasian, Han Chinese, Jewish, and Malay have the potential to determine factors related to methadone treatment factors (dose and concentration in the blood). Moreover, genetic variations in gene encoding for the enzymes involved in methadone metabolism have the potential to determine methadone treatment factors (dose and concentration in the blood) in Caucasian (CYP2B6, CYP2D6, CYP3A4), Han Chinese (CYP2B6, CYP2C19), and Jewish (CYP2B6).

What do these findings mean?

This review indicates potential genetic markers to predict treatment outcomes in methadone treatment. However, the findings of the studies included in this review article are limited to specific races or ethnicities. Different genetic markers are useful for specific races or ethnicity.

How this might influence/change clinical practice?

Specific genetic markers may be useful in the clinical setting to predict the treatment outcomes. The patients may benefit from the use of genetic markers in the methadone maintenance treatment program as the treatment can be individualized based on individual genetic data. This may enhance treatment effectiveness and prevent complications due to under or overtreatment. Future studies should include larger sample size, replication studies in other population, the inclusion of various factors in the analysis, the use of machine learning and artificial intelligence.

More information:
Ramli FF. Pharmacogenomics biomarkers for personalized methadone maintenance treatment: The mechanism and its potential use. Bosn J of Basic Med Sci. 2020

Provided by Association of Basic Medical Sciences of FBIH