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Does cardiology hold pharmacogenetics to an inconsistent standard? A comparison of evidence among recommendations

Jasmine A Luzum1, Jason C Cheung1,2

  • 1Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI, USA.

Pharmacogenomics
|September 11, 2018
PubMed

Insights

Pharmacogenetic testing for clopidogrel is recommended despite lacking randomized controlled trials, contradicting current guidelines. Evidence supports clopidogrel testing more than other recommended pharmacogenetic tests.

Area of Science:

  • Pharmacogenomics
  • Clinical Pharmacology
  • Cardiovascular Medicine

Background:

  • Current American Heart Association/American College of Cardiology (AHA/ACC) guidelines recommend against routine pharmacogenetic testing for clopidogrel.
  • This recommendation contrasts with the Clinical Pharmacogenetics Implementation Consortium and US Food and Drug Administration (FDA) stances.
  • The AHA/ACC cites a lack of randomized controlled trials demonstrating improved patient outcomes as the basis for their recommendation.

Purpose of the Study:

  • To compare the evidence supporting pharmacogenetic testing for clopidogrel with that of other pharmacogenetic tests recommended by the AHA/ACC and National Comprehensive Cancer Network (NCCN).
  • To evaluate the consistency of guideline recommendations regarding pharmacogenetic testing in the absence of randomized controlled trial evidence.

Main Methods:

  • A comparative analysis of existing evidence for pharmacogenetic tests recommended by major health organizations.
  • Focus on clopidogrel pharmacogenetic testing in patients undergoing percutaneous coronary intervention.

Main Results:

  • The evidence supporting pharmacogenetic testing for clopidogrel is more robust than for other pharmacogenetic tests endorsed by the AHA/ACC and NCCN.
  • Guideline discrepancies exist regarding the necessity of randomized controlled trials for recommending pharmacogenetic tests.

Conclusions:

  • Pharmacogenetic testing for clopidogrel may be warranted despite current guideline limitations.
  • There is a need for re-evaluation of guideline recommendations for pharmacogenetic testing based on comprehensive evidence, not solely randomized controlled trials.

Keywords:
American Heart Association/American College of CardiologyNational Comprehensive Cancer Networkclopidogrelepidermal growth factor receptor inhibitorsguidelineslong QT syndromepharmacogeneticsrecommendationsthiopurines

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