دورية أكاديمية
Cost Effectiveness of Genotype-Guided Antiplatelet Therapy in Asian Ischemic Stroke Patients: Ticagrelor as an Alternative to Clopidogrel in Patients with CYP2C19 Loss of Function Mutations.
| العنوان: | Cost Effectiveness of Genotype-Guided Antiplatelet Therapy in Asian Ischemic Stroke Patients: Ticagrelor as an Alternative to Clopidogrel in Patients with CYP2C19 Loss of Function Mutations. |
|---|---|
| المؤلفون: | Narasimhalu K; Department of Neurology (SGH Campus), National Neuroscience Institute, Outram Road, 169608, Singapore, Singapore. nkaavya@gmail.com., Ang YK; Policy, Research and Evaluation Division, Ministry of Health, Singapore, Singapore.; Sydney Medical School, University of Sydney, Sydney, NSW, Australia., Tan DSY; Policy, Research and Evaluation Division, Ministry of Health, Singapore, Singapore.; Khoo Teck Puat Hospital, Singapore, Singapore., De Silva DA; Department of Neurology (SGH Campus), National Neuroscience Institute, Outram Road, 169608, Singapore, Singapore., Tan KB; Policy, Research and Evaluation Division, Ministry of Health, Singapore, Singapore.; School of Public Health, National University of Singapore, Singapore, Singapore. |
| المصدر: | Clinical drug investigation [Clin Drug Investig] 2020 Nov; Vol. 40 (11), pp. 1063-1070. |
| نوع المنشور: | Comparative Study; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Adis, Springer International Country of Publication: New Zealand NLM ID: 9504817 Publication Model: Print Cited Medium: Internet ISSN: 1179-1918 (Electronic) Linking ISSN: 11732563 NLM ISO Abbreviation: Clin Drug Investig Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Auckland : Adis, Springer International Original Publication: Mairangi Bay, Auckland, N.Z. ; Philadelphia : Adis International, c1995- |
| مواضيع طبية MeSH: | Clopidogrel/*administration & dosage , Ischemic Stroke/*drug therapy , Platelet Aggregation Inhibitors/*administration & dosage , Ticagrelor/*administration & dosage, Aged ; Asian People ; Brain Ischemia/drug therapy ; Cost-Benefit Analysis ; Cytochrome P-450 CYP2C19/genetics ; Genotype ; Humans ; Loss of Function Mutation ; Middle Aged ; Quality-Adjusted Life Years |
| مستخلص: | Background: Patients with ischemic stroke are often treated with clopidogrel monotherapy as part of secondary stroke prevention. The prevalence of loss of function (LOF) mutations in the CYP2C19 gene is higher in Asians than in Western populations. Patients with loss of function (LOF) mutations are at risk for poorer secondary outcomes when prescribed clopidogrel. Objective: We aimed to determine the cost effectiveness of genotype-guided antiplatelet therapy in an Asian population with the aim of prescribing ticagrelor as an alternative to patients with LOF mutations. Methods: Markov models were developed to look at the cost effectiveness of genetic testing of CYP2C19, with patients who screened positive for LOF alleles being switched to ticagrelor compared to universal clopidogrel treatment. Effect ratios were obtained from the literature and incidence rates and costs were obtained from the national data published by the Singapore Ministry of Health. Lifetime costs and quality-adjusted life-years (QALYs) were calculated. The primary endpoints were the incremental cost-effectiveness ratios (ICERs). Results: The prevalence of the LOF mutations was 61% in the population, with 65% of ethnic Chinese, 60% of ethnic Indian, and 53% of ethnic Malay patients having LOF mutations. Based on this prevalence, the overall ICER of genetic testing was S$33,839/QALY with ICERS of S$30,755/QALY, S$33,177/QALY, and S$41,470/QALY for Chinese, Indians, and Malays, respectively. Conclusion: This study suggests that it is cost effective to screen for LOF mutations in the CYP2C19 gene in ischemic stroke populations, with ticagrelor as a substitute for clopidogrel in those with LOF mutations. |
| التعليقات: | Comment in: Clin Drug Investig. 2021 Jan;41(1):115-116. (PMID: 33237558) |
| References: | Kernan WN, Ovbiagele B, Black HR, et al (2014) Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. CAPRIE Steering committee. A randomized blinded trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet. 1996;348:1329–39. (PMID: 10.1016/S0140-6736(96)09457-3) Sangkuhl K, Klein TE, Altman RB (2010) Clopidogrel pathway. Pharmacogenet. Genomics. Goh LL, Lim CW, Sim WC, et al. Analysis of genetic variation in CYP450 genes for clinical implementation. PLoS One. 2017. https://doi.org/10.1371/journal.pone.0169233 . (PMID: 10.1371/journal.pone.0169233290919545665602) Aw JWX, Tan DSY, Goh LL (2018) Letter by Aw et al Regarding Article, Clinical Outcomes and Sustainability of Using CYP2C19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary Intervention. Circ. Genomic Precis. Med. Johnston SC, Amarenco P, Albers GW, et al. Ticagrelor versus aspirin in acute stroke or transient ischemic attack. N Engl J Med. 2016. https://doi.org/10.1056/NEJMoa1603060 . (PMID: 10.1056/NEJMoa160306027705253) Evaluation, Institute for Health Metrics and; Epidemiology & Disease Control Division MoH S (2019) The Burden of Disease in Singapore, 1990–2017: An overview of the Global Burden of Disease Study 2017 results. Seattle. NRoD O (2018) Singapore Stroke Registry Annual Report 2016. Department of Statistics MoTI R of S (2018) Complete Life Tables for Singapore Resident Population, 2017–2018. Sun W, Li Y, Li J, et al. Variant recurrent risk among stroke patients with different CYP2C19 phenotypes and treated with clopidogrel. Platelets. 2015. https://doi.org/10.3109/09537104.2014.953044 . (PMID: 10.3109/09537104.2014.95304426619766) Amarenco P, Albers GW, Denison H, et al. Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial. Lancet Neurol. 2017. https://doi.org/10.1016/S1474-4422(17)30038-8 . (PMID: 10.1016/S1474-4422(17)30038-828238711) Putaala J. Long-term mortality after first-ever and recurrent stroke in young adults. Stroke. 2014. https://doi.org/10.1161/STROKEAHA.114.005648 . (PMID: 10.1161/STROKEAHA.114.00564825325910) Wallentin L, James S, Storey RF, et al. Effect of CYP2C19 and ABCB1 single nucleotide polymorphisms on outcomes of treatment with ticagrelor versus clopidogrel for acute coronary syndromes: A genetic substudy of the PLATO trial. Lancet. 2010. https://doi.org/10.1016/S0140-6736(10)61274-3 . (PMID: 10.1016/S0140-6736(10)61274-321059484) Guzauskas GF, Boudreau DM, Villa KF, et al. The cost-effectiveness of primary stroke centers for acute stroke care. Stroke. 2012. https://doi.org/10.1161/STROKEAHA.111.648238 . (PMID: 10.1161/STROKEAHA.111.64823822535277) Daly TM, Dumaual CM, Miao X, et al. Multiplex assay for comprehensive genotyping of genes involved in drug metabolism, excretion, and transport. Clin Chem. 2007. https://doi.org/10.1373/clinchem.2007.086348 . (PMID: 10.1373/clinchem.2007.08634817510302) Dumaual C, Miao X, Daly TM, et al (2007) Comprehensive assesment of metabolic enzyme and transporter genes using the affymetrix® targeted genotyping system. Pharmacogenomics. WHO (World Health Organization) Cost effectiveness and strategic planning (WHO-CHOICE). https://www.who.int/choice/cost-effectiveness/methods/en/. Accessed 27 Aug 2020. Bertram MY, Lauer JA, De Joncheere K, et al. Cost-effectiveness thresholds: Pros and cons. Bull World Health Organ. 2016. https://doi.org/10.2471/BLT.15.164418 . (PMID: 10.2471/BLT.15.164418279942855153921) Sorich MJ, Horowitz JD, Sorich W, et al. Cost-effectiveness of using CYP2C19 genotype to guide selection of clopidogrel or ticagrelor in Australia. Pharmacogenomics. 2013. https://doi.org/10.2217/pgs.13.164 . (PMID: 10.2217/pgs.13.16424279856) Chin CT, Mellstrom C, Chua TSJ, Matchar DB (2013) Lifetime cost-effectiveness analysis of ticagrelor in patients with acute coronary syndromes based on the PLATO trial: A Singapore healthcare perspective. Singapore Med J. https://doi.org/10.11622/smedj.2013045. Patel V, Lin F-J, Ojo O, et al. Cost-utility analysis of genotype-guided antiplatelet therapy in patients with moderate-to-high risk acute coronary syndrome and planned percutaneous coronary intervention. Pharm Pract. 2014. https://doi.org/10.4321/s1886-36552014000300007 . (PMID: 10.4321/s1886-36552014000300007) Lala A, Berger JS, Sharma G, et al. Genetic testing in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A cost-effectiveness analysis. J Thromb Haemost. 2013. https://doi.org/10.1111/jth.12059 . (PMID: 10.1111/jth.1205923137413) Kim K, Touchette DR, Cavallari LH, et al. Cost-Effectiveness of Strategies to Personalize the Selection of P2Y12 Inhibitors in Patients with Acute Coronary Syndrome. Cardiovasc Drugs Ther. 2019. https://doi.org/10.1007/s10557-019-06896-8 . (PMID: 10.1007/s10557-019-06896-831367811) Xie HG, Stein CM, Kim RB, et al. Allelic, genotypic and phenotypic distributions of S-mephenytoin 4’-hydroxylase (CYP2C19) in healthy Caucasian populations of European descent throughout the world. Pharmacogenetics. 1999. https://doi.org/10.1097/00008571-199910000-00001 . (PMID: 10.1097/00008571-199910000-0000110780271) Tang XF, Wang J, Zhang JH, et al. Effect of the CYP2C19*2 and*3 genotypes, ABCB1 C3435T and PON1 Q192R alleles on the pharmacodynamics and adverse clinical events of clopidogrel in Chinese people after percutaneous coronary intervention. Eur J Clin Pharmacol. 2013. https://doi.org/10.1007/s00228-012-1446-8 . (PMID: 10.1007/s00228-012-1446-824150533) Shetkar SS, Ramakrishnan S, Seth S, et al. CYP 450 2C19 polymorphisms in Indian patients with coronary artery disease. Indian Heart J. 2014. https://doi.org/10.1016/j.ihj.2013.10.001 . (PMID: 10.1016/j.ihj.2013.10.001254436114223213) Lamba JK, Dhiman RK, Kohli KK. CΥP2C19 genetic mutation in North Indians. Clin Pharmacol Ther. 2000. https://doi.org/10.1067/mcp.2000.109365 . (PMID: 10.1067/mcp.2000.10936511014415) Kimura M, Ieiri I, Mamiya K, et al. Genetic polymorphism of cytochrome P450s, CYP2C19, and CYP2C9 in a Japanese population. Ther Drug Monit. 1998. https://doi.org/10.1097/00007691-199806000-00001 . (PMID: 10.1097/00007691-199806000-000019631918) Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013. https://doi.org/10.1056/NEJMoa1215340 . (PMID: 10.1056/NEJMoa1215340243690493913536) Claiborne Johnston S, Donald Easton J, Farrant M, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med. 2018. https://doi.org/10.1056/NEJMoa1800410 . (PMID: 10.1056/NEJMoa180041029766750) Chi NF, Wen CP, Liu CH, et al. Comparison between aspirin and clopidogrel in secondary stroke prevention based on real-world data. J Am Heart Assoc. 2018. https://doi.org/10.1161/JAHA.118.009856 . (PMID: 10.1161/JAHA.118.009856303713216404870) Wang Y, Zhao X, Lin J, et al. Association between CYP2C19 loss-of-function allele status and efficacy of clopidogrel for risk reduction among patients with minor stroke or transient ischemic attack. J Am Med Assoc. 2016. https://doi.org/10.1001/jama.2016.8662 . (PMID: 10.1001/jama.2016.8662) |
| المشرفين على المادة: | 0 (Platelet Aggregation Inhibitors) A74586SNO7 (Clopidogrel) EC 1.14.14.1 (CYP2C19 protein, human) EC 1.14.14.1 (Cytochrome P-450 CYP2C19) GLH0314RVC (Ticagrelor) |
| تواريخ الأحداث: | Date Created: 20200922 Date Completed: 20201222 Latest Revision: 20221207 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1007/s40261-020-00970-y |
| PMID: | 32959334 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 1179-1918 |
|---|---|
| DOI: | 10.1007/s40261-020-00970-y |