Cavallari Larisa H
a Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics , University of Florida College of Pharmacy , Gainesville , FL , USA.
Expert Rev Cardiovasc Ther. 2017 Aug;15(8):581-589. doi: 10.1080/14779072.2017.1355236. Epub 2017 Jul 19.
Clopidogrel is commonly prescribed with aspirin to reduce the risk for adverse cardiovascular events after percutaneous coronary intervention (PCI). However, there is significant inter-patient variability in clopidogrel response. The CYP2C19 enzyme is involved in the biotransformation of clopidogrel to its pharmacologically active form, and variation in the CYP2C19 gene contributes to clopidogrel response variability. Areas covered. This article describes the impact of CYP2C19 genotype on clopidogrel pharmacokinetics, pharmacodynamics, and effectiveness. Examples of clinical implementation of CYP2C19 genotype-guided antiplatelet therapy for patients undergoing PCI are also described as are emerging outcomes data with this treatment approach. Expert commentary. A large clinical trial evaluating outcomes with CYP2C19 genotype-guided antiplatelet therapy after PCI is on-going. In the meantime, data from pragmatic and observational studies and smaller trials support improved outcomes with genotyping after PCI and use of alternative antiplatelet therapy in patients with a CYP2C19 genotype associated with reduced clopidogrel effectiveness.
氯吡格雷通常与阿司匹林联合使用，以降低经皮冠状动脉介入治疗（PCI）后发生不良心血管事件的风险。然而，患者对氯吡格雷的反应存在显著的个体差异。CYP2C19酶参与氯吡格雷向其药理活性形式的生物转化，CYP2C19基因的变异导致了氯吡格雷反应的个体差异。涵盖领域。本文描述了CYP2C19基因型对氯吡格雷药代动力学、药效学和有效性的影响。还介绍了CYP2C19基因型指导的抗血小板治疗在接受PCI患者中的临床应用实例，以及这种治疗方法的最新疗效数据。专家评论。一项评估PCI后CYP2C19基因型指导的抗血小板治疗疗效的大型临床试验正在进行中。与此同时，来自实用和观察性研究以及小型试验的数据支持在PCI后进行基因分型可改善疗效，并支持在氯吡格雷有效性降低的CYP2C19基因型患者中使用替代抗血小板治疗。
