Key result
Dual antiplatelet therapy with clopidogrel and aspirin compared to aspirin alone showed no significant interaction with CYP2C19 loss-of-function carrier status for major ischemia (interaction P=0.36).
Why the study?
Following findings in the CHANCE trial of an interaction between CYP2C19 loss-of-function alleles and dual antiplatelet therapy efficacy, this substudy evaluated whether a similar interaction existed in the POINT trial.
Does dual antiplatelet therapy (aspirin and clopidogrel) reduce major ischemia compared to aspirin alone in patients with acute TIA or minor stroke based on CYP2C19 loss-of-function allele status?
Comparison
Dual antiplatelet therapy with aspirin and clopidogrel vs aspirin alone across CYP2C19 loss-of-function carrier status
Design
Multicenter randomized trial substudy
Authors
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CYP2C19 status does not appear to modify DAPT effects; leaves open whether genotyping should guide therapy in stroke.
RCT (n=932)
Yes
Does dual antiplatelet therapy (aspirin and clopidogrel) reduce major ischemia compared to aspirin alone in patients with acute TIA or minor stroke based on CYP2C19 loss-of-function allele status?
Hazard Ratio: 0.33 (95% CI 0.09–1.21)
Absolute Event Rate: 2.3% vs 6.7%
p-value: p=0.09
In patients with acute TIA or minor stroke, CYP2C19 loss-of-function carrier status did not significantly modify the treatment effect of dual antiplatelet therapy versus aspirin alone for preventing major ischemia.
Meschia et al. (2020) conducted an RCT in Acute transient ischemic attack or minor ischemic stroke (n=932). Dual antiplatelet therapy (aspirin and clopidogrel) vs. Aspirin alone was evaluated on Major ischemia (ischemic stroke, myocardial infarction, or ischemic vascular death) among CYP2C19 loss-of-function allele carriers (HR 0.33, 95% CI 0.09-1.21, p=0.09). Dual antiplatelet therapy with clopidogrel and aspirin compared to aspirin alone showed no significant interaction with CYP2C19 loss-of-function carrier status for major ischemia (interaction P=0.36).
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