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The effect of CYP2C19 gene polymorphisms on the pharmacokinetics and pharmacodynamics of prasugrel 5-mg, prasugrel 10-mg and clopidogrel 75-mg in patients with coronary artery disease
Sinai Centre Thrombosis Research, MD 21215 USA.
St Antonius Hospital, Netherlands.
Sinai Centre Thrombosis Research, MD 21215 USA.
St Antonius Hospital, Netherlands.
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2014 (English)In: Thrombosis and Haemostasis, ISSN 0340-6245, Vol. 112, no 3, 589-597 p.Article in journal (Refereed) Published
Abstract [en]

CYP2C19 genotype has been shown to impact response to clopidogrel 75-mg but not prasugrel 10-mg. Here, we assessed effects of CYP2C19 metaboliser status on pharmacokinetics (PK) and pharmacodynamic (PD) responses to prasugrel 5-mg and 10-mg and clopidogrel 75-mg using data from two PK/PD studies in stable coronary artery disease (CAD) patients (GENERATIONS and FEATHER). Active metabolite concentrations (area under the curve, AUC([0-tlast])), maximum platelet aggregation (MPA) measured by light transmission aggregometry, vasodilator-stimulated phosphoprotein platelet reactivity index, and VerifyNow P2Y12-platelet reaction units (VN-PRU) were analysed by CYP2C19-predicted phenotype (extensive metaboliser [EM; N=154], *2-*8 non-carriers, vs reduced metaboliser [RM; N=41],*2-*8 carriers/*17 non-carriers). AUC((0-tlast)) was unaffected by metaboliser status for prasugrel 5-mg and 10-mg (geometric mean EM/RM ratios 1.00, 95% confidence interval [Cl]: 0.86,1.17, pgreater than0.99; and 0.97, 95% CI:0.85,1.12, p=0.71, respectively), but was lower among RMs receiving clopidogrel 75-mg (1.37, 95% CI:1.14,1.65, pless than0.001). Platelet reactivity was not significantly affected by CYP2C19 metaboliser status for prasugrel 5-mg, or for prasugrel 10-mg by MPA and VN-PRU, but for clopidogrel 75-mg was significantly higher in reduced metabolisers (all measures pless than0.01). Prasugrel 10-mg showed greater antiplatelet effects vs clopidogrel 75-mg (all comparisons pless than0.001). Prasugrel 5-mg showed greater antiplatelet effects vs clopidogrel 75-mg in RMs (all pless than0.001), and comparable effects in EMs (all p greater than= 0.37). In contrast to clopidogrel, prasugrel active metabolite PK was not influenced by CYP2C19 genotype. Antiplatelet effect for prasugrel 10-mg was greater irrespective of metaboliser status and for prasugrel 5-mg was greater for RMs and comparable for EMs as compared to clopidogrel 75-mg.

Place, publisher, year, edition, pages
Schattauer , 2014. Vol. 112, no 3, 589-597 p.
Keyword [en]
Prasugrel; clopidogrel; CYP2C19; platelet reactivity; coronary artery disease
National Category
Clinical Medicine
URN: urn:nbn:se:liu:diva-111270DOI: 10.1160/TH13-10-0891ISI: 000341547000019PubMedID: 25008027OAI: diva2:755558

Funding Agencies|Daiichi Sankyo Co., Ltd.; Eli Lilly and Company

Available from: 2014-10-14 Created: 2014-10-14 Last updated: 2014-11-26

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Lindahl, Tomas
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