Projected impact of pharmacogenomic testing on medications beyond antiplatelet therapy in percutaneous coronary intervention patients

Pharmacogenomics. 2020 May;21(7):431-441. doi: 10.2217/pgs-2019-0185. Epub 2020 Apr 28.

Abstract

Aim:CYP2C19 genotyping is used to guide antiplatelet therapy after percutaneous coronary intervention (PCI). This study evaluated the potential impact of CYP2C19 and multigene pharmacogenomics (PGx) testing on medications beyond antiplatelet therapy in a real-world cohort of PCI patients that underwent CYP2C19 testing. Methodology & results: Multiple medications with actionable PGx recommendations, including proton pump inhibitors, antidepressants and opioids, were commonly prescribed. Approximately 50% received a CYP2C19 metabolized medication beyond clopidogrel and 7% met criteria for a CYP2C19 genotype-guided intervention. A simulation analysis projected that 17.5 PGx-guided medication interventions per 100 PCI patients could have been made if multigene PGx results were available. Conclusion: This suggests that CYP2C19 and multigene PGx results could be used to optimize medication prescribing beyond antiplatelet therapy in PCI patients.

Keywords: CYP2C19; clopidogrel; genetic testing; percutaneous coronary intervention; pharmacogenomics; precision medicine.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Clopidogrel / administration & dosage
  • Clopidogrel / adverse effects
  • Cohort Studies
  • Cytochrome P-450 CYP2C19 / genetics*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / methods*
  • Percutaneous Coronary Intervention / trends
  • Pharmacogenetics / methods
  • Pharmacogenetics / trends
  • Pharmacogenomic Testing / methods*
  • Pharmacogenomic Testing / trends
  • Platelet Aggregation Inhibitors / administration & dosage
  • Platelet Aggregation Inhibitors / adverse effects*
  • Prasugrel Hydrochloride / administration & dosage
  • Prasugrel Hydrochloride / adverse effects
  • Retrospective Studies
  • Ticagrelor / administration & dosage
  • Ticagrelor / adverse effects

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • CYP2C19 protein, human
  • Cytochrome P-450 CYP2C19
  • Prasugrel Hydrochloride
  • Ticagrelor