Clinical pharmacists use CYP2C19 genotyping test to guide individual medication therapy of Clopidogrel and to evaluate the efficacy of treatment

doi:10.12092/j.issn.1009-2501.2019.08.015

Abstract

Abstract:

AIM: To investigate the significance of clinical pharmacists using CYP2C19 gene polymorphism to guide patients with clopidogrel individualized medication and to further explore the difference in therapeutic effect between different medication therapy in intermediate and poor metabolizers. METHODS: A total of 200 patients with clinical CYP2C19 genotyping test of clopidogrel in our hospital from November 2016 to December 2017 were enrolled in this study. Clinical pharmacists made individualized medication suggestions for patients according to genotypes. For extensive metabolizer, clopidogrel treatment should be continued; for intermediate and poor metabolizers, the alternative anti-platelet medication therapy was recommended. In order to compare the efficacy between the continuing clopidogrel treatment group and the alternative anti-platelet medication therapy group recommended by clinical pharmacist, follow-up was conducted after 12 months.RESULTS:According to inclusion and exclusion standard, 200 patients were enrolled. Among the patients, there were 74 intermediate metabolizers for 37.00%; and there were 43 poor metabolizers for 21.50%. According to genotypes of clopidogrel in 200 patients, clinical pharmacists made individualized medication suggestions for anti-platelet medication therapy, and the adoption rate was 62.00%. Among them, the opinions of extensive metabolizer were entirely adopted. While the adoption rate of intermediate and poor metabolizers were only 35.04%. After 12 months, 117 intermediate and poor metabolizers were followed up, and a total of 23 patients were lost to follow-up. There was no significant difference in the incidence of adverse cardiovascular events between the alternative anti-platelet medication therapy group recommended by clinical pharmacist (n=32) and the continuing clopidogrel treatment group (n=62) (P>0.05). CONCLUSION:Clinical pharmacists can guide the individualized medication according to CYP2C19 gene polymorphism. For intermediate and poor metabolizer, alternative anti-platelet medication therapy cannot reduce the risk of adverse cardiovascular events.

Key words: clopidogrel, CYP2C19 genotyping test, clinical pharmacist, individualized medication therapy, anti-platelet therapy

CLC Number:

R541

YANG Rui, LIU Hui, CHEN Zeheng, QI Tingting，ZHANG Zanling, QU Qiang. Clinical pharmacists use CYP2C19 genotyping test to guide individual medication therapy of Clopidogrel and to evaluate the efficacy of treatment[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(8): 938-943.

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