Clopidogrel and genetic testing: Is it necessary for everyone?

Sweta Goswami, Angela Cheng-Lai, James Nawarskas

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Clopidogrel is a widely used antiplatelet agent to treat and prevent a variety of atherothrombotic diseases. More than a decade after its initial Food and Drug Administration approval, studies have emerged raising concerns regarding its possible reduced efficacy in patients who have impaired conversion of clopidogrel to its active metabolite (ie, poor metabolizers). Research has implicated genetic variations in the CYP2C19 isozyme as at least partly responsible for the variable antiplatelet response seen with clopidogrel. Studies have shown that patients possessing genetic variants of the CYP2C19 isozyme may be at increased risk of adverse cardiovascular events due to impaired clopidogrel efficacy, although this has not been definitively demonstrated. The Food and Drug Administration has issued a boxed warning regarding this concern. However, specific recommendations on genetic testing and alternative therapeutic strategies are not currently available. Genetic testing is commercially available to test patients for variability in the CYP2C19 isozyme, but altering antiplatelet therapy based on the results of this testing has not been adequately studied, and it is therefore not clear how to adjust therapy based on the results of this genetic testing. In addition, there are many other factors that may contribute to the variability in antiplatelet effect seen with clopidogrel besides CYP2C19 genetic polymorphisms. Ongoing trials dealing with adjusting antiplatelet therapy based on genetic testing will hopefully provide more useful information on how to appropriately integrate pharmacogenomics with the care of patients with atherothrombotic disease.

Original languageEnglish (US)
Pages (from-to)96-100
Number of pages5
JournalCardiology in Review
Volume20
Issue number2
DOIs
StatePublished - Mar 2012

Fingerprint

clopidogrel
Genetic Testing
Isoenzymes
United States Food and Drug Administration
Drug Labeling
Drug Approval
Pharmacogenetics
Platelet Aggregation Inhibitors
Genetic Polymorphisms
Therapeutics
Patient Care
Cytochrome P-450 CYP2C19

Keywords

  • clopidogrel
  • CYP2C19
  • genetic polymorphisms
  • genetic variants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clopidogrel and genetic testing : Is it necessary for everyone? / Goswami, Sweta; Cheng-Lai, Angela; Nawarskas, James.

In: Cardiology in Review, Vol. 20, No. 2, 03.2012, p. 96-100.

Research output: Contribution to journalArticle

Goswami, Sweta ; Cheng-Lai, Angela ; Nawarskas, James. / Clopidogrel and genetic testing : Is it necessary for everyone?. In: Cardiology in Review. 2012 ; Vol. 20, No. 2. pp. 96-100.
@article{168510c702604956ad2b0c97307f5497,
title = "Clopidogrel and genetic testing: Is it necessary for everyone?",
abstract = "Clopidogrel is a widely used antiplatelet agent to treat and prevent a variety of atherothrombotic diseases. More than a decade after its initial Food and Drug Administration approval, studies have emerged raising concerns regarding its possible reduced efficacy in patients who have impaired conversion of clopidogrel to its active metabolite (ie, poor metabolizers). Research has implicated genetic variations in the CYP2C19 isozyme as at least partly responsible for the variable antiplatelet response seen with clopidogrel. Studies have shown that patients possessing genetic variants of the CYP2C19 isozyme may be at increased risk of adverse cardiovascular events due to impaired clopidogrel efficacy, although this has not been definitively demonstrated. The Food and Drug Administration has issued a boxed warning regarding this concern. However, specific recommendations on genetic testing and alternative therapeutic strategies are not currently available. Genetic testing is commercially available to test patients for variability in the CYP2C19 isozyme, but altering antiplatelet therapy based on the results of this testing has not been adequately studied, and it is therefore not clear how to adjust therapy based on the results of this genetic testing. In addition, there are many other factors that may contribute to the variability in antiplatelet effect seen with clopidogrel besides CYP2C19 genetic polymorphisms. Ongoing trials dealing with adjusting antiplatelet therapy based on genetic testing will hopefully provide more useful information on how to appropriately integrate pharmacogenomics with the care of patients with atherothrombotic disease.",
keywords = "clopidogrel, CYP2C19, genetic polymorphisms, genetic variants",
author = "Sweta Goswami and Angela Cheng-Lai and James Nawarskas",
year = "2012",
month = "3",
doi = "10.1097/CRD.0b013e3182455744",
language = "English (US)",
volume = "20",
pages = "96--100",
journal = "Cardiology in Review",
issn = "1061-5377",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Clopidogrel and genetic testing

T2 - Is it necessary for everyone?

AU - Goswami, Sweta

AU - Cheng-Lai, Angela

AU - Nawarskas, James

PY - 2012/3

Y1 - 2012/3

N2 - Clopidogrel is a widely used antiplatelet agent to treat and prevent a variety of atherothrombotic diseases. More than a decade after its initial Food and Drug Administration approval, studies have emerged raising concerns regarding its possible reduced efficacy in patients who have impaired conversion of clopidogrel to its active metabolite (ie, poor metabolizers). Research has implicated genetic variations in the CYP2C19 isozyme as at least partly responsible for the variable antiplatelet response seen with clopidogrel. Studies have shown that patients possessing genetic variants of the CYP2C19 isozyme may be at increased risk of adverse cardiovascular events due to impaired clopidogrel efficacy, although this has not been definitively demonstrated. The Food and Drug Administration has issued a boxed warning regarding this concern. However, specific recommendations on genetic testing and alternative therapeutic strategies are not currently available. Genetic testing is commercially available to test patients for variability in the CYP2C19 isozyme, but altering antiplatelet therapy based on the results of this testing has not been adequately studied, and it is therefore not clear how to adjust therapy based on the results of this genetic testing. In addition, there are many other factors that may contribute to the variability in antiplatelet effect seen with clopidogrel besides CYP2C19 genetic polymorphisms. Ongoing trials dealing with adjusting antiplatelet therapy based on genetic testing will hopefully provide more useful information on how to appropriately integrate pharmacogenomics with the care of patients with atherothrombotic disease.

AB - Clopidogrel is a widely used antiplatelet agent to treat and prevent a variety of atherothrombotic diseases. More than a decade after its initial Food and Drug Administration approval, studies have emerged raising concerns regarding its possible reduced efficacy in patients who have impaired conversion of clopidogrel to its active metabolite (ie, poor metabolizers). Research has implicated genetic variations in the CYP2C19 isozyme as at least partly responsible for the variable antiplatelet response seen with clopidogrel. Studies have shown that patients possessing genetic variants of the CYP2C19 isozyme may be at increased risk of adverse cardiovascular events due to impaired clopidogrel efficacy, although this has not been definitively demonstrated. The Food and Drug Administration has issued a boxed warning regarding this concern. However, specific recommendations on genetic testing and alternative therapeutic strategies are not currently available. Genetic testing is commercially available to test patients for variability in the CYP2C19 isozyme, but altering antiplatelet therapy based on the results of this testing has not been adequately studied, and it is therefore not clear how to adjust therapy based on the results of this genetic testing. In addition, there are many other factors that may contribute to the variability in antiplatelet effect seen with clopidogrel besides CYP2C19 genetic polymorphisms. Ongoing trials dealing with adjusting antiplatelet therapy based on genetic testing will hopefully provide more useful information on how to appropriately integrate pharmacogenomics with the care of patients with atherothrombotic disease.

KW - clopidogrel

KW - CYP2C19

KW - genetic polymorphisms

KW - genetic variants

UR - http://www.scopus.com/inward/record.url?scp=84857356069&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84857356069&partnerID=8YFLogxK

U2 - 10.1097/CRD.0b013e3182455744

DO - 10.1097/CRD.0b013e3182455744

M3 - Article

C2 - 22293861

AN - SCOPUS:84857356069

VL - 20

SP - 96

EP - 100

JO - Cardiology in Review

JF - Cardiology in Review

SN - 1061-5377

IS - 2

ER -