Switching from prasugrel to clopidogrel based on Cytochrome P450 2C19 genotyping in East Asian patients stabilized after acute myocardial infarction

Ji Hyun Lee, Sung Gyun Ahn, Jun Won Lee, Young Jin Youn, Min Soo Ahn, Jang Young Kim, Byung Su Yoo, Seung Hwan Lee, Junghan Yoon, Juwon Kim, Eunhee Choi, Sang Yong Yoo, Olivia Y. Hung, Habib Samady

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Abstract

To evaluate the pharmacodynamic efficacy of de-escalating P2Y12 inhibition from prasugrel to clopidogrel based on cytochrome P450 (CYP) 2C19 genotyping, we genotyped 50 Korean patients with AMI who underwent percutaneous coronary intervention (PCI) for CYP2C19 *2,*3, or *17 using real-time PCR. They were discharged on prasugrel 10 mg daily. A control group of 48 AMI patients who underwent PCI and were discharged on clopidogrel but did not undergo genotyping was identified retrospectively. Based on genotyping results available at 3 weeks, 12 patients found to have 2 copies of either CYP2C19 *2 or *3 loss of function alleles continued prasugrel while the remaining 38 patients switched to clopidogrel 75 mg daily. The rate of patients within the therapeutic window (TW) of on-treatment platelet reactivity (OPR), 85<P2Y12 reactivity unit (PRU) ≤275, was compared in the genotype-directed cohort before (3 weeks) and after genotype-directed antiplatelet treatment (5 weeks), as well as with the control cohort at 5 weeks. In the genotype-directed group, there was an increase in the proportion of patients within the TW after genotype-directed antiplatelet treatment (48–76%, p=0.007), primarily driven by a decrease of patients with PRU <85 (52–16%, p <0.001). The proportion of patients within the TW was similar between the genotype-guided and control groups (76% vs. 72.9% p=0.726). In conclusion, individualized antiplatelet regimens based on CYP2C19 genotyping may improve likelihood of achieving a TW of OPR compared to fixed dose of prasugrel 10 mg during maintenance periods of AMI in East Asians.

Original languageEnglish
Pages (from-to)301-307
Number of pages7
JournalPlatelets
Volume27
Issue number4
DOIs
Publication statusPublished - 2016 May 18

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All Science Journal Classification (ASJC) codes

  • Hematology

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