Projected Impact of Pharmacogenomic Testing on Medications Beyond Antiplatelet Therapy in Percutaneous Coronary Intervention Patients

Abstract

Aim: CYP2C19 genotyping is used to guide antiplatelet therapy after percutaneous coronary intervention (PCI). This study evaluated the potential impact of CYP2C19 and multigene pharmacogenomics (PGx) testing on medications beyond antiplatelet therapy in a real-world cohort of PCI patients that underwent CYP2C19 testing. Methodology & results: Multiple medications with actionable PGx recommendations, including proton pump inhibitors, antidepressants and opioids, were commonly prescribed. Approximately 50% received a CYP2C19 metabolized medication beyond clopidogrel and 7% met criteria for a CYP2C19 genotype-guided intervention. A simulation analysis projected that 17.5 PGx-guided medication interventions per 100 PCI patients could have been made if multigene PGx results were available. Conclusion: This suggests that CYP2C19 and multigene PGx results could be used to optimize medication prescribing beyond antiplatelet therapy in PCI patients.

Keywords::

• clopidogrel
• CYP2C19
• genetic testing
• percutaneous coronary intervention
• pharmacogenomics
• precision medicine

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: https://www.tandfonline.com/doi/suppl/10.2217/pgs-2019-0185

Financial & competing interests disclosure

The project was supported by the National Center for Advancing Translational Sciences (NCATS), the NIH, through grant award number UL1TR002489, and in part by UNC Eshelman Institute for Innovation pilot grant RX03612214 to T Wiltshire. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

The project was supported by the National Center for Advancing Translational Sciences (NCATS), the NIH, through grant award number UL1TR002489, and in part by UNC Eshelman Institute for Innovation pilot grant RX03612214 to T Wiltshire. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.