Clinical outcomes of CYP2C19 genotype-guided antiplatelet therapy: existing evidence and future directions

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Candidate Gene Testing in Clinical Cohort Studies with Multiplexed Genotyping and Mass Spectrometry
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Candidate Gene Testing in Clinical Cohort Studies with Multiplexed Genotyping and Mass Spectrometry

Published on: June 21, 2018

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Melissa D Klein1, Craig R Lee2,3,4, George A Stouffer1,2

  • 1Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Pharmacogenomics
|July 21, 2018
PubMed

Insights

CYP2C19 genotype affects clopidogrel response but not prasugrel or ticagrelor. Genotype-guided antiplatelet therapy shows promise for precision cardiovascular medicine, addressing implementation gaps.

Area of Science:

  • Pharmacogenomics
  • Cardiovascular Medicine
  • Precision Medicine

Background:

  • CYP2C19 nonfunctional *2 and *3 polymorphisms reduce clopidogrel's effectiveness.
  • This impairment increases cardiovascular event risk after percutaneous coronary intervention.
  • CYP2C19 genotype does not affect prasugrel or ticagrelor response.

Purpose of the Study:

  • To review recent data on CYP2C19 genotype-guided antiplatelet therapy.
  • To provide insight into the clinical utility of this precision medicine approach.
  • To address knowledge gaps impeding widespread implementation.

Main Methods:

  • Critical evaluation of recent studies.
  • Analysis of clinical outcomes data.
  • Review of current clinical practice guidelines.

Main Results:

  • Recent studies are evaluating the impact of CYP2C19 genotype-guided antiplatelet selection on clinical outcomes.
  • Data is beginning to clarify the clinical utility of this approach.
  • Uncertainty regarding implementation is decreasing.

Conclusions:

  • CYP2C19 genotype is a critical factor for clopidogrel efficacy.
  • Prasugrel and ticagrelor offer alternative antiplatelet options independent of CYP2C19 genotype.
  • Genotype-guided antiplatelet therapy represents a significant advancement in precision cardiovascular medicine.
Keywords:
CYP2C19clopidogrelguidelinespersonalized medicinepharmacogenomicsprasugrelstentticagrelor

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