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A multicomponent intervention incorporating CYP2C19 genotype-guided therapy and integrated pharmaceutical care

Dan Zhang1, Zhongru Meng1, Yufei Li1

  • 1Department of Pharmacy, The First People's Hospital of Yancheng, Yancheng First Hospital Affiliated Hospital of Nanjing University Medical School, Yancheng, Jiangsu, China.

Frontiers in Neurology
|August 13, 2026
PubMed

Insights

Integrating CYP2C19 genotype-guided antiplatelet therapy with pharmacist care improved medication adherence and reduced hospitalizations in ischemic stroke patients, especially high-risk individuals. This approach enhances patient outcomes without increasing adverse reactions.

Area of Science:

  • Pharmacogenomics
  • Clinical Pharmacy
  • Stroke Medicine

Background:

  • Ischemic stroke patients face challenges with antiplatelet therapy due to CYP2C19 genetic variations and poor medication adherence.
  • The effectiveness of combining genetic testing with comprehensive pharmaceutical care for stroke prevention is not well-established across different risk groups.

Purpose of the Study:

  • To evaluate a pharmacist-led intervention integrating CYP2C19 genotype-guided antiplatelet therapy versus routine care in ischemic stroke patients.
  • To assess the impact on medication adherence, hospitalization frequency, and adverse drug reactions.

Main Methods:

  • A single-center, prospective, randomized controlled trial involving 300 ischemic stroke patients.
  • Intervention group received CYP2C19 genotype-guided antiplatelet therapy and pharmacist care; control group received routine care.
  • Outcomes assessed included medication adherence, hospitalization rates, and adverse reactions over one year.

Main Results:

  • The individualized treatment group showed significantly higher medication adherence (adjusted mean difference=0.533, p<0.001) and lower hospitalization frequency (IRR=0.700, p=0.049) compared to the control group.
  • Benefits were more pronounced in high-risk patients (ESRS ≥ 3), with significantly reduced hospitalizations (IRR=0.640, p=0.033).
  • No significant difference in adverse reactions was observed between groups (OR=0.543, p=0.072).

Conclusions:

  • A multicomponent intervention combining CYP2C19 genotype-guided therapy and pharmacist care improves adherence and reduces hospitalizations in ischemic stroke patients.
  • High-risk patients experienced the most significant benefits in reducing hospitalizations.
  • The intervention enhanced outcomes without increasing adverse drug reactions, though the specific contribution of genotyping alone requires further study.
Abstract

Keywords:
CYP2C19 geneindividualized treatmentintegrated pharmaceutical careischemic strokemedication adherence

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