Effect of CYP2C19 status on platelet reactivity in Taiwanese acute coronary syndrome patients switching to prasugrel from clopidogrel: Switch Study

Kuo, Feng-Yu; Lee, Cheng‐Han; Lan, Weihua; Su, Cheng‐Huang; Lee, Wen-Lieng; Wang, Yi‐Chih; Lin, Wei‐Shiang; Chu, Pao-Hsien; Lu, Tse‐Min; Lo, Ping‐Han; Tsukiyama, Shuji; Yang, Wei-Chen; Cheng, Li-Chung; Huang, Chien-Lung; Yin, Wei‐Hsian; Liu, Ping-Yen

doi:10.1016/j.jfma.2022.01.013

Cited by 7 publications

(9 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A high prevalence of CYP2C19 loss‐of‐function alleles in East Asian populations (50%–60%) compared with Western populations (30%) has raised concerns about the efficacy and safety of clopidogrel therapy in these patients 27,28 . In a study involving Taiwanese acute coronary syndrome patients, 56.9% of patients had at least one CYP2C19 loss‐of‐function allele, 29 and the prevalence is similar to other studies in Taiwan 30,31 . However, East Asians have a different risk–benefit profile for antithrombotic therapy compared to Western populations, with a higher incidence of bleeding complications and similar or lower rates of ischemic events at the same level of platelet reactivity compared with Caucasian patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of generic versus brand‐name clopidogrel for secondary prevention in patients with acute myocardial infarction: A nationwide cohort study

Chan

Tung

Lee

et al. 2023

Clinical Translational Sci

View full text Add to dashboard Cite

Skepticism exists among healthcare workers and patients regarding the efficacy and safety of generic medication, despite its potential to lower healthcare costs. This study aimed to compare the outcomes of a generic clopidogrel and its brand‐name counterpart for secondary prevention in patients with acute myocardial infarction (AMI). Using the Taiwan National Health Insurance Research Database, we identified 49,325 patients who were hospitalized for AMI between January 1, 2008 and December 31, 2013 and prescribed either generic or brand‐name clopidogrel. Among them, 2419 (4.9%) were prescribed the generic clopidogrel. After propensity score matching, both the generic and brand‐name groups consisted of 2382 patients. The primary efficacy outcome was a composite of myocardial infarction, coronary revascularization, ischemic stroke, and all‐cause death. The primary safety outcome was major bleeding requiring hospitalization. At a mean follow‐up of 2.5 years, the generic and brand‐name clopidogrel groups had comparable risks of primary efficacy outcome (41.9% vs. 42%; hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.88–1.04), and the risks of the individual components were also similar. There were no significant differences between the two groups in major bleeding (7.9% vs. 7.9%; HR 0.99; 95% CI 0.81–1.21). Subgroup analyses also revealed no statistically significant interactions between the treatment effect and various subgroups. In this retrospective database analysis, the generic clopidogrel was comparable to its brand‐name counterpart regarding cardiovascular and bleeding outcomes for the treatment of patients with AMI.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of generic versus brand‐name clopidogrel for secondary prevention in patients with acute myocardial infarction: A nationwide cohort study

Chan

Tung

Lee

et al. 2023

Clinical Translational Sci

View full text Add to dashboard Cite

show abstract

“…CLI management has evolved from open surgery to an endovascular approach, and the refinements in endovascular intervention have improved its outcomes 6) . To maintain the patency of target vessels after endovascular intervention, the use of antiplatelet drugs to suppress platelet reactivity is crucial [7][8][9] . Clopidogrel is frequently prescribed in Asians and is associated with a lower risk of gastrointestinal bleeding compared with aspirin or other P2Y12 inhibitors 8,[10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

“…To maintain the patency of target vessels after endovascular intervention, the use of antiplatelet drugs to suppress platelet reactivity is crucial [7][8][9] . Clopidogrel is frequently prescribed in Asians and is associated with a lower risk of gastrointestinal bleeding compared with aspirin or other P2Y12 inhibitors 8,[10][11][12] . However, loss-offunction (LOF) alleles of the cytochrome P450 2C19 (CYP2C19) enzyme are associated with a poor response to clopidogrel and result in high platelet reactivity 8,13) .…”

Section: Introductionmentioning

confidence: 99%

“…Clopidogrel is frequently prescribed in Asians and is associated with a lower risk of gastrointestinal bleeding compared with aspirin or other P2Y12 inhibitors 8,[10][11][12] . However, loss-offunction (LOF) alleles of the cytochrome P450 2C19 (CYP2C19) enzyme are associated with a poor response to clopidogrel and result in high platelet reactivity 8,13) . Compared with non-carriers, CYP2C19 LOF allele carriers, especially in Asian populations, were found to have a greater risk of adverse cardiovascular events while receiving clopidogrel for coronary artery disease (CAD) 8,13) .…”

Section: Introductionmentioning

confidence: 99%

“…Two independent CAD cohorts in France, the Popular (Do Platelet Function Assays Predict Clinical Outcomes in Clopidogrel-Pretreated Patients Undergoing Elective PCI) and the FAST-MI (Registry of Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction) registries, also validated this score 19,20) . However, the frequencies of CYP2C19 LOF and obesity vary between Asian and Western populations 8,13,21) . Besides, whether this score can also be applied in the risk assessment of patients with CLI remains unknown.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Utility of the ACD-GENE-CLI Score in Asian Patients with Critical Limb Ischemia Undergoing Endovascular Interventions

Chang,

Huang,

et al. 2024

JAT

View full text Add to dashboard Cite

Aims: Critical limb ischemia (CLI) is an emerging public health threat and lacks a reliable score for predicting the outcomes. The Age, Body Mass Index, Chronic Kidney Disease, Diabetes, and Genotyping (ABCD-GENE) risk score helps identify patients with coronary artery disease who have cytochrome P450 2C19 ( CYP2C19 ) polymorphism-related drug resistance and are at risk for cardiovascular adverse events. However, its application to CLI remains unknown. In this study, we aim to validate a modified ACD-GENE-CLI score to improve the prediction of major adverse limb events (MALEs) in patients with CLI receiving clopidogrel. Methods: Patients with CLI receiving clopidogrel post-endovascular intervention were enrolled prospectively in two medical centers. Amputation and revascularization as MALEs were regarded as the outcomes. Results: A total of 473 patients were recruited, with a mean follow-up duration of 25 months. Except for obesity, old age, diabetes, chronic kidney disease (CKD), and CYP2C19 polymorphisms were significantly associated with MALEs. Using bootstrap regression analysis, we established a modified risk score (ACD-GENE-CLI) that included old age (≥ 65 years), diabetes, CKD, and CYP2C19 polymorphisms. At a cutoff value of 8, the ACD-GENE-CLI score was superior to the CYP2C19 deficiency only, and the conventional ABCD-GENE score in predicting MALEs (area under the curve: 0.69 vs. 0.59 vs. 0.67, p =0.01). The diagnostic ability of the ACD-GENE-CLI score was consistent in the external validation. Also, Kaplan–Meier curves showed that in CYP2C19 deficiency, the ABCD-GENE and ACD-GENE-CLI scores could all differentiate patients with CLI who are free from MALEs. Conclusions: The modified ACD-GENE-CLI score could differentiate patients with CLI receiving clopidogrel who are at risk of MALEs. Further studies are required to generalize the utility of the score.

show abstract

Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in East-Asian Patients with Acute Coronary Syndrome: Large Cohort Study

Lee,

Fang,

Tsai

et al. 2023

Am J Cardiovasc Drugs

View full text Add to dashboard Cite

Effect of CYP2C19 status on platelet reactivity in Taiwanese acute coronary syndrome patients switching to prasugrel from clopidogrel: Switch Study

Cited by 7 publications

References 41 publications

Clinical outcomes of generic versus brand‐name clopidogrel for secondary prevention in patients with acute myocardial infarction: A nationwide cohort study

Clinical outcomes of generic versus brand‐name clopidogrel for secondary prevention in patients with acute myocardial infarction: A nationwide cohort study

Utility of the ACD-GENE-CLI Score in Asian Patients with Critical Limb Ischemia Undergoing Endovascular Interventions

Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in East-Asian Patients with Acute Coronary Syndrome: Large Cohort Study

Contact Info

Product

Resources

About