A recent study conducted by investigators from the UNC Department of Medicine and the UNC Eshelman School of Pharmacy was recognized as one of the top 10 advances in genomic medicine in 2019, as chosen by the NIH’s National Human Genome Research Institute’s Genomic Medicine Working Group (learn more from the CDC Office of Genomics and Precision Health blog). This study evaluated the frequency and clinical impact of changes in antiplatelet therapy after percutaneous coronary intervention (PCI) using CYP2C19 genotyping to guide selection of P2Y12 inhibitors.
The CYP2C19 genotype plays a role in the metabolism of commonly prescribed drugs, including clopidogrel, also known as Plavix. Since results of genotype testing are generally obtained after PCI, CYP2C19-guided selection of antiplatelet therapy can require switching between P2Y12 inhibitors in practice (commonly used agents include clopidogrel, ticagrelor, and prasugrel).
Led by Jesse Martin, BS, a UNC Doctor of Pharmacy student, the study showed that the continued use of clopidogrel in patients who are genetic ‘non-responders’ to clopidogrel (i.e. they have nonfunctional alleles) is associated with adverse outcomes. In contrast, use of clopidogrel following PCI in patients without a nonfunctional allele is safe and effective. The study was published in the January, 2020, issue of Genetics in Medicine.
Other authors of the study included Alexis K. Williams, PharmD; Melissa D. Klein, BS; Vindhya B. Sriramoju, MD; Shivanshu Madan, MD; Joseph S. Rossi, MD; Megan Clarke, PharmD; Jonathan D. Cicci, PharmD, Larisa H. Cavallari, PharmD; Karen E. Weck, MD; George Stouffer, MD; and Craig R. Lee, PharmD, PhD.
The UNC Program for Precision Medicine in Healthcare is currently building clinical decision support in the electronic health record, to help optimize the return of CYP2C19 genetic test results to providers.