Key result
CYP2C19 pharmacogenetic testing was mainly prescribed by neurologists after clopidogrel initiation, and pharmacogenetic resistance was associated with substitution to lysine acetylsalicylate.
Why the study?
The study aimed to evaluate the prescription characteristics of CYP2C19 pharmacogenetics in patients on clopidogrel treatment using a clinical data warehouse query.
Observational
No
CYP2C19 pharmacogenetic testing for clopidogrel is primarily used reactively by neurologists for suspected stroke relapse, highlighting the need for clear clinical practice guidelines regarding its positioning.
Reactive CYP2C19 testing after clopidogrel start may leave patients on suboptimal therapy; leaves open whether preemptive genotyping improves outcomes.
Clopidogrel is one of the most prescribed antiplatelet drugs for cardiovascular diseases prevention. Clopidogrel is a prodrug metabolised by CYP2C19 in active metabolites with anti-aggregant effect. Pharmacogenetic variants such as CYP2C19*2 variant can alter the anti-aggregant effect of clopidogrel leading to a higher risk of cardiovascular disease relapse. The aim of this study was to evaluate the prescription characteristics of CYP2C19 pharmacogenetics in patients on clopidogrel treatment, based on a specific query in a clinical data warehouse. We evaluated the demographics of patients, prescribers, medical indications, CYP2C19 pharmacogenetic tests and therapeutic changes. Neurologists were the main prescribers of CYP2C19 pharmacogenetic tests associated with clopidogrel treatment in a context of suspicion of stroke relapse. Pharmacogenetic tests were mainly prescribed a posteriori to clopidogrel prescription. Clopidogrel pharmacogenetic resistance was associated with the prescription of lysine acetylsalicylate in substitution of clopidogrel. Clear clinical practice guidelines are needed to position CYP2C19 pharmacogenetic testing for patients on clopidogrel treatment.
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Maes et al. (2023) conducted an observational in Patients on clopidogrel treatment. CYP2C19 pharmacogenetic testing was evaluated on Prescription characteristics and therapeutic changes. CYP2C19 pharmacogenetic testing was mainly prescribed by neurologists after clopidogrel initiation, and pharmacogenetic resistance was associated with substitution to lysine acetylsalicylate.
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