Algorithms for personalized administration of non-steroidal anti-inflammatory drugs for patients with chronic pelvic pain syndrome based on pharmacogenetic testing

Background. Therapy for chronic pelvic pain syndrome (CPPS) consists in long-term analgesia with non-steroidal anti-inflammatory drugs (NSAIDs), which is associated with the development of unwanted side effects, especially in elderly patients with comorbid pathology. Objective. Development of algorithms for personalized administration of NSAIDs for patients with CPPS, taking into account the carriage of polymorphic CYP2C9 alleles and the presence of comorbid pathology. Methods. The clinical comparison groups were stratified according to the carriage of the CYP2C9 alleles. NM-metabolizers (n=70) and PM-metabolizers (n=32) received NSAIDs taking into account the CYP2C9 genotype and the presence of comorbid pathology. NM-metabolizers were prescribed celebrex in a daily dose of 200 mg. PM-metabolizers received aceclofenac at a daily dose of 200 mg/day, divided into 2 doses. The control group (n=50) received NSAID therapy according to generally accepted standards: diclofenac sodium was prescribed at a dose of 75 mg/day. Efficiency and safety were assessed on the 7th day of inpatient treatment. Results. In all study groups, including the control group, the pain intensity index according to the VAS decreased by more than 30% by the 7th day of therapy, indicating an equivalent clinical efficacy of NSAIDs. The indicators of the quality of life of patients with CPPS, determined using the WHOQOL-BREF questionnaire, more significantly increased in patients receiving therapy based on the results of pharmacogenetic testing: t=4.02; p<0.001 (18.3±0.59 versus 22.8±0.95); t=3.71; p<0.001 (15.98±0.76 versus 19.92±0.74); t=2.15; p<0.05 (22.18±0.64 versus 25.29±1.3). With a comparable efficacy of NSAID therapy, NSAID tolerance was better in the groups of patients treated taking into account CYP2C9 genotypes and comorbid pathology. In these groups, the incidence of side effects (cardiovascular and gastrointestinal) was minimal: 3 (9.37%) versus 6 (12%), versus 20 (40%), Fisher's method (p=0, 0238 and p=0.0020, respectively). Conclusion. According to the results of the study, it was found that the therapy of patients with CPPS, taking into account pharmacogenetic testing, gradation of risk factors and the presence of comorbid pathology, is effective and safest.

CYP2C9, chronic pelvic pain syndrome, non-steroidal anti-inflammatory drugs, pharmacogenetics, CYP2C9, personalized algorithms