A Pharmacodynamic Study Comparing Prasugrel Versus Ticagrelor in Patients Undergoing PCI With CYP2C19 Loss-of-function:
Status:
Completed
Trial end date:
2019-04-22
Target enrollment:
Participant gender:
Summary
Numerous studies have shown that pharmacodynamics (PD) response profiles vary among
clopidogrel treated patients and that individuals with reduced response have an increased
risk of recurrent ischemic events. There are multiple factors contributing to clopidogrel
response variability, including genetic variations of the cytochrome P450 (CYP) 2C19 enzyme.
In particular, loss-of-function (LOF) alleles of the CYP2C19 enzyme reduce transformation of
clopidogrel pro-drug into its active metabolite. Thus, patients carrying LOF alleles have
lower levels of clopidogrel's active metabolite as well as diminished platelet inhibition,
which translates into an increased rate of adverse cardiovascular events, particularly in the
setting of percutaneous coronary intervention (PCI). Prasugrel and ticagrelor are novel
generation P2Y12 receptor inhibitors characterized by greater PD potency and reduced ischemic
event rates compared with clopidogrel, and are not affected by CYP2C19 LOF polymorphisms.
However, to date there are limited head-to-head PD comparisons between these two new P2Y12
receptors blockers, and there are no studies assessing on how these agents behave among
CYP2C19 LOF carriers. The aim of the present study is to compare the PD effects of prasugrel
versus ticagrelor in patients undergoing PCI with CYP2C19 LOF alleles using the novel
point-of-care genetic testing Spartan RX-CYP2C19 which permits accurate and rapid
identification of CYP2C19 genetic status.