Why the study?
The authors sought to update their prior network meta-analysis of five trials comparing ticagrelor/aspirin versus clopidogrel/aspirin in patients with minor stroke or TIA.
Does ticagrelor plus aspirin or clopidogrel plus aspirin reduce recurrent stroke or death in adult patients with minor ischemic stroke or TIA compared to aspirin alone?
Does ticagrelor plus aspirin or clopidogrel plus aspirin reduce recurrent stroke or death in adult patients with minor ischemic stroke or TIA compared to aspirin alone?
Patients with CYP2C19 loss-of-function alleles represent a distinct subpopulation in their antiplatelet response, suggesting that genotype-guided trials like CHANCE2 cannot be generalized to the broader stroke population without routine genotyping.
Significant inconsistency precludes updated NMA estimates; leaves open comparative efficacy of ticagrelor/aspirin versus clopidogrel/aspirin in CYP2C19 loss-of-function carriers.
We previously analyzed five trials on ticagrelor/aspirin versus clopidogrel/aspirin in patients with minor stroke/ TIA in a network meta-analysis. We updated our search and identified 311 new citations with one study for inclusion: CHANCE2 enrolled patients with CYP2C19 loss-of-function alleles and randomized them to ticagrelor/aspirin or clopidogrel/aspirin. Pooling of CHANCE2 with the original studies could not be completed due to violation of NMA assumptions, due to significant inconsistency. This suggests patients with CYP2C19 loss-of-function alleles represent a subpopulation that is inherently different from the general stroke population in their antiplatelet response. Results from CHANCE-2 may not be generalizable without genotype testing.
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Lun et al. (2023) studied this question.
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