Key result
CYP2C9/VKORC1-guided warfarin reduces time to first therapeutic INR and increases time in therapeutic range.
Why the study?
Variations in genotypes were observed in RCTs evaluating genotype-based warfarin dosing, leaving unclear whether clinically significant differences exist among different genotype-guided strategies.
Does genotype-based warfarin dosing improve time to therapeutic INR and time in therapeutic range compared to traditional dosing in patients requiring warfarin?
Comparison
CYP2C9 alone vs CYP2C9 with VKORC1 vs CYP2C9, VKORC1, and CYP4F2 vs traditional dosing
Design
Network meta-analysis of RCTs
Authors
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Genotype-guided warfarin dosing shortens time to therapeutic INR and boosts TTR; reinforces meta-analytic support for routine pharmacogenetic testing at initiation.
Meta-Analysis (n=7,898)
Does genotype-based warfarin dosing improve time to therapeutic INR and time in therapeutic range compared to traditional dosing in patients requiring warfarin?
Effect estimate: WMD -1.92 (95% CI -3.23, -0.61)
Personalizing warfarin dose based on CYP2C9 and VKORC1 genotypes improves time to therapeutic INR and time in therapeutic range compared to traditional dosing strategies.
Sridharan et al. (2020) conducted a meta-analysis in Patients requiring warfarin therapy (n=7,898). Genotype-based warfarin dosing (CYP2C9, VKORC1, CYP4F2) vs. Traditional-dosing strategies was evaluated on Time to first therapeutic INR (CYP2C9 and VKORC1 vs traditional) (WMD -1.92, 95% CI -3.23, -0.61). Personalizing warfarin dose based on CYP2C9 and VKORC1 genotypes reduced time to first therapeutic INR (WMD -1.92; 95% CI -3.23, -0.61) and increased time in therapeutic range.
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