Clopidogrel versus Ticagrelor in CYP2C19 Loss-of-Function Allele Noncarriers: A Real-World Study in China

Yunnan Zhang; Yi Zhang; Xiujin Shi; Baidi Lin; Jialun Han; Yifan Wang; Jialin Yan; Wenxing Peng; Wenzheng Li; Ze Zheng; Yang Lin

doi:10.1055/s-0041-1735193

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2022; 122(05): 842-852
DOI: 10.1055/s-0041-1735193

Atherosclerosis and Ischaemic Disease

Clopidogrel versus Ticagrelor in CYP2C19 Loss-of-Function Allele Noncarriers: A Real-World Study in China

Authors

Yunnan Zhang

¹Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

²School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
Yi Zhang

¹Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

²School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
Xiujin Shi

¹Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Baidi Lin

¹Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

²School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
Jialun Han

¹Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

²School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
Yifan Wang

¹Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

²School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
Jialin Yan

¹Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

²School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
Wenxing Peng

¹Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Wenzheng Li

³Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Ze Zheng

³Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Yang Lin

¹Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

²School of Pharmaceutical Sciences, Capital Medical University, Beijing, China

Abstract

Objective This article compares the clinical outcomes of clopidogrel and ticagrelor in patients with acute coronary syndrome (ACS) without cytochrome P450 (CYP)2C19 loss-of-function (LOF) alleles and investigates whether clopidogrel could be an alternative P2Y12 inhibitor without increasing the risk of ischemic events.

Methods Patients were divided into the clopidogrel-treated group and the ticagrelor-treated group. Inverse probability of treatment weighting (IPTW) calculated by propensity scores was used to adjust confounding covariates. The primary outcome was major adverse cardiovascular or cerebrovascular events (MACCEs) within 12 months. The secondary outcomes were MACCEs plus unstable angina, and clinically significant bleeding events.

Results Finally, 2,199 patients were included. Of them, 1,606 were treated with clopidogrel, and 593 were treated with ticagrelor. The mean age of the original cohort was 59.92 ± 9.81 years. During the 12-month follow-up period, MACCEs occurred in 89 patients (4.0%). No significant differences were observed in MACCEs (IPTW-adjusted hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.65–1.18), MACCEs plus unstable angina (IPTW-adjusted HR, 1.20; 95% CI, 0.91–1.59), or clinically significant bleeding events (IPTW-adjusted HR, 0.81; 95% CI, 0.53–1.23) between the clopidogrel- and ticagrelor-treated groups.

Conclusion In patients with ACS without CYP2C19 LOF alleles, clopidogrel was not associated with a higher risk of MACCEs when compared with ticagrelor. The main findings of this study support use of clopidogrel in CYP2C19 LOF noncarriers as an alternative P2Y12 inhibitor, which may reduce medical expenses and adverse reactions caused by more potent P2Y12 inhibitors in these patients.

Keywords

clopidogrel - ticagrelor - CYP2C19 - antiplatelet therapy - acute coronary syndrome

Full Text

References

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