Genotype-guided antiplatelet therapy compared with conventional therapy for patients with acute coronary syndromes: a systematic review and meta-analysis

Zheng, Lukai; Yang, Chunsong; Xiang, Lingbao; Zeng, Hao

doi:10.1080/1354750x.2019.1634764

Cited by 15 publications

(9 citation statements)

References 29 publications

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“…The GIANT (NCT01134380) study 44 showed a similar outcome, and thus it was vital to verify the potential benefit of the genotype-guided personalized test. To date, four meta-analyses on genotype-guided antiplatelet therapy versus conventional antiplatelet treatment have been conducted, [18][19][20][21] yielding different conclusions.…”

Section: The Conclusion Was Not Based Solely On High-quality Evidencementioning

confidence: 99%

“…Two of the studies included only RCTs, 18,19 while the other two included both RCTs and non-RCTs. 20,21 Kheiri et al found that MACE was not significantly reduced in patients undergoing genotype-guided therapy after a pooled analysis of six RCTs. 18 Lyu et al updated the evidence by adding two large RCTs (the POPular Genetics study and the TAILOR-PCI study) and a significant but slightly decreased risk of MACE was observed.…”

Section: The Conclusion Was Not Based Solely On High-quality Evidencementioning

confidence: 99%

“…19 The other two meta-analyses including RCTs and non-RCTs, from the inception of the database to September 2018, demonstrated that genotype-guided treatment reduced the incidence of several ischemic events significantly without increasing the risk of bleeding. 20,21 First, to the best of our knowledge, the present study included eight RCTs and eight non-RCTs and involved a larger population (10 561 patients) compared with prior meta-analyses. Second, comprehensive outcome indicators were compared, for example the risk of cardiovascular death was not compared in cohort studies in the previous meta-analysis.…”

Section: The Conclusion Was Not Based Solely On High-quality Evidencementioning

confidence: 99%

“…Previous systematic reviews [18][19][20][21] did not include all RCT and non-RCT studies focusing on this issue. Thus, we aimed to conduct an updated meta-analysis by performing subgroup analyses at the same time and determine if a personalized strategy based on genotyping is superior to conventional therapy.…”

Section: Introductionmentioning

confidence: 99%

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Genotype‐guided antiplatelet treatment versus conventional therapy: A systematic review and meta‐analysis

Zhang

Xiang

Liu

et al. 2020

Brit J Clinical Pharma

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This meta-analysis was carried out to explore if a personalized antiplatelet strategy based on genotyping is superior to conventional therapy.Methods: PubMed, Web of Science, EMBASE and the Cochrane Library were searched from the inception of each database to 5 May 2020. Studies reporting endpoints in genotype-guided treatment group and conventional treatment group were included. The endpoint results were presented as the risk ratio (RR), with 95% confidence interval (CI).Results: A total of 10 561 patients from 16 studies (eight randomized controlled trials [RCT] and eight cohort studies) were included in the meta-analysis. The rates of major adverse cardiovascular events (MACE), stent thrombosis and myocardial infarction (MI) were significantly lower in the genotype-guided group than in the conventional treatment group (RR 0.56, 95% CI 0.44-0.73, P < .0001; RR 0.40, 95% CI 0.24-0.67, P = .0005; RR 0.45, 95% CI 0.35-0.58, P < .00001, respectively).A significant difference was found between the two groups in major bleeding (RR 0.73, 95% CI 0.55-0.98, P = .04), which was not robust after sensitivity analysis. Conclusion:Genotype-guided antiplatelet treatment could decrease the risk of MACE, stent thrombosis and MI in patients with coronary artery disease or undergoing percutaneous coronary intervention, without increasing the risk of bleeding over a long follow-up period. The decreased risk of efficacy outcomes was more obvious in cohort studies. Well-organized RCTs and clinical trials are required to verify the benefit of genotype-guided therapy.

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Section: The Conclusion Was Not Based Solely On High-quality Evidencementioning

confidence: 99%

Section: The Conclusion Was Not Based Solely On High-quality Evidencementioning

confidence: 99%

Section: The Conclusion Was Not Based Solely On High-quality Evidencementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Genotype‐guided antiplatelet treatment versus conventional therapy: A systematic review and meta‐analysis

Zhang

Xiang

Liu

et al. 2020

Brit J Clinical Pharma

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“…The importance of pharmacogenomic guidance is shown by a systematic review of five studies (total n = 2900 patients, average age 67 years) of the effects of CYP2C19 variants on the outcomes of myocardial infarcts, revascularisation, stroke or death. For patients who received genotype-guided therapy 125 (8.9%) had one of these outcomes and in the conventionally dosed patients 239 (15.9%) RR 0.54 (95%CI 0.41-0.72; I 2 30%) [101].…”

Section: Clopidogrelmentioning

confidence: 99%

Optimising Seniors’ Metabolism of Medications and Avoiding Adverse Drug Events Using Data on How Metabolism by Their P450 Enzymes Varies with Ancestry and Drug–Drug and Drug–Drug–Gene Interactions

Thomas

2020

JPM

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Many individuals ≥65 have multiple illnesses and polypharmacy. Primary care physicians prescribe >70% of their medications and renew specialists’ prescriptions. Seventy-five percent of all medications are metabolised by P450 cytochrome enzymes. This article provides unique detailed tables how to avoid adverse drug events and optimise prescribing based on two key databases. DrugBank is a detailed database of 13,000 medications and both the P450 and other complex pathways that metabolise them. The Flockhart Tables are detailed lists of the P450 enzymes and also include all the medications which inhibit or induce metabolism by P450 cytochrome enzymes, which can result in undertreatment, overtreatment, or potentially toxic levels. Humans have used medications for a few decades and these enzymes have not been subject to evolutionary pressure. Thus, there is enormous variation in enzymatic functioning and by ancestry. Differences for ancestry groups in genetic metabolism based on a worldwide meta-analysis are discussed and this article provides advice how to prescribe for individuals of different ancestry. Prescribing advice from two key organisations, the Dutch Pharmacogenetics Working Group and the Clinical Pharmacogenetics Implementation Consortium is summarised. Currently, detailed pharmacogenomic advice is only available in some specialist clinics in major hospitals. However, this article provides detailed pharmacogenomic advice for primary care and other physicians and also physicians working in rural and remote areas worldwide. Physicians could quickly search the tables for the medications they intend to prescribe.

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Oral Antiplatelet Agents in Percutaneous Coronary Intervention

Rowland¹,

Batty²,

Dangas³

et al. 2022

Interventional Cardiology

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Genotype-guided antiplatelet therapy compared with conventional therapy for patients with acute coronary syndromes: a systematic review and meta-analysis

Cited by 15 publications

References 29 publications

Genotype‐guided antiplatelet treatment versus conventional therapy: A systematic review and meta‐analysis

Genotype‐guided antiplatelet treatment versus conventional therapy: A systematic review and meta‐analysis

Optimising Seniors’ Metabolism of Medications and Avoiding Adverse Drug Events Using Data on How Metabolism by Their P450 Enzymes Varies with Ancestry and Drug–Drug and Drug–Drug–Gene Interactions

Oral Antiplatelet Agents in Percutaneous Coronary Intervention

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