Does a CYP2C9- VKORC1- CYP4F2-based pharmacogenetic algorithm improve anticoagulation control compared to standard clinical dosing in naïve patients with non-valvular atrial fibrillation?
Genotype-guided warfarin dosing does not significantly improve overall time in therapeutic range compared to standard clinical care in naïve patients with non-valvular atrial fibrillation, though it may reduce time spent at extreme supratherapeutic INRs.
UNLABELLED: Genotype-guided warfarin dosing have been proposed to improve patient’s management. This study is aimed to determine whether a CYP2C9- VKORC1- CYP4F2-based pharmacogenetic algorithm is superior to a standard, clinically adopted, pharmacodynamic method. Two-hundred naïve patients with non-valvular atrial fibrillation were randomized to trial arms and 180 completed the study. No significant differences were found in the number of out-of-range INRs (INR3.0) (p = 0.79) and in the mean percentage of time spent in the therapeutic range (TTR) after 19 days in the pharmacogenetic (51.9%) and in the control arm (53.2%, p = 0.71). The percentage of time spent at INR>4.0 was significantly lower in the pharmacogenetic (0.7%) than in the control arm (1.8%) (p = 0.02). Genotype-guided warfarin dosing is not superior in overall anticoagulation control when compared to accurate clinical standard of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT01178034.
Pengo et al. (Mon,) studied this question.