Does Metabolizer Status Matter in Acute Coronary Syndromes Treated With Prasugrel vs Clopidogrel?

MedicalResearch.com Interview with:

Professor Keith AA Fox Duke of Edinburgh Professor of Cardiology University of Edinburgh

Prof. Keith Fox

Professor Keith AA Fox
Duke of Edinburgh Professor of Cardiology
University of Edinburgh

Medical Research: What is the background for this study?

Prof. Fox: From previous reports, certain alleles of CYP2C19 are associated with reduced enzymatic function and reduced conversion of clopidogrel to the active metabolite. Patients carrying these reduced function alleles (reduced metabolizers) exhibit higher platelet reactivity when treated with clopidogrel, compared with patients without reduced-function alleles (extensive metabolizers). However, the relationship of CYP2C19 genotype and outcomes in medically managed patients with acute coronary syndromes (ACS) is not known.

Medical Research: What are the main findings?

Prof. Fox: There was no association between CYP2C19 metabolizer status (EM vs. RM) and the primary composite endpoint of cardiovascular death, myocardial infarction (MI), or stroke (hazard ratio : 0.86). EM and RM patients had similar rates of the primary endpoint whether treated with prasugrel (HR: 0.82) or clopidogrel (HR: 0.91; p for
interaction non significant).

Medical Research: What should clinicians and patients take away from your report?

Prof. Fox: CYP2C19 metabolizer status is not associated with the composite outcome of cardiovascular death, MI, or stroke in medically managed acute coronary syndromes patients treated with clopidogrel or prasugrel. Our findings do not support routine CYP2C19 genetic testing in this population. The findings in this population of medically treated patients after ACS (from the TRILOGY Trial) do not apply to ACS managed with PCI intervention, when prasugrel was shown to be superior to clopidogrel.

Medical Research: What recommendations do you have for future research as a result of this study?

Prof. Fox: This study did confirm prior observations of the relationship of CYP2C19 metabolizer status with platelet reactivity, but importantly, the superior impact of prasugrel on suppressing platelet reactivity did not translate into superior outcomes. Future research is needed to understand the reasons for this.

Citation:

Professor Keith AA Fox (2016). Does Metabolizer Status Matter in Acute Coronary Syndromes Treated With Prasugrel vs Clopidogrel? MedicalResearch.co