Thromb Haemost 2014; 111(05): 943-950
DOI: 10.1160/TH13-09-0767
Cardiovascular Biology and Cell Signalling
Schattauer GmbH

Clopidogrel metaboliser status based on point-of-care CYP2C19 genetic testing in patients with coronary artery disease

David Erlinge
1  Department of Cardiology, Lund University, Lund, Sweden
,
Stefan James
2  Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Sweden
,
Suman Duvvuru
3  Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
,
Joseph A. Jakubowski
3  Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
,
Henrik Wagner
1  Department of Cardiology, Lund University, Lund, Sweden
,
Christoph Varenhorst
2  Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Sweden
,
Udaya S. Tantry
4  Sinai Center for Thrombosis Research, Baltimore, MD, USA
,
Patricia B. Brown
3  Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
,
David Small
3  Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
,
Brian A. Moser
3  Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
,
Scott S. Sundseth
5  Cabernet Pharmaceuticals Durham, NC, USA
,
Joseph R. Walker
6  Daiichi Sankyo Pharma Development, Edison, NJ, USA
,
Kenneth J. Winters
3  Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
,
Paul A. Gurbel
4  Sinai Center for Thrombosis Research, Baltimore, MD, USA
› Author Affiliations
Financial support: This study was funded by Daiichi Sankyo Co., Ltd., Tokyo, Japan and by Eli Lilly and Company, Indianapolis, Indiana, USA.
Further Information

Publication History

Received: 17 September 2013

Accepted after minor revision: 26 January 2013

Publication Date:
21 November 2017 (online)

Summary

We compared results obtained with the Nanosphere Verigene® System, a novel point-of-care (POC) genetic test capable of analysing 11 CYP2C19 variants within 3 hours, to an established, validated genotyping method (Affymetrix™ DMET+; reference assay) for identifying extensive and reduced metabolisers of clopidogrel. Based on genotyping, patients (N=82) with stable coronary artery disease on clopidogrel 75 mg daily were defined as extensive metabolisers (*1/*1, *1/*17, *17/*17), reduced metabolisers (*1/*2, *1/*8, *2/*2, *2/*3), or of indeterminate metaboliser status (*2/*17). Pharmacokinetic exposure to clopidogrel’s active metabolite and pharmacodynamic measures with P2Y12 reaction units (PRU) (VerifyNow® P2Y12 assay) and VASP PRI (PRI) were also assessed. There was a 99.9% overall concordance of marker-level data between the Nanosphere Verigene and DMET+ systems in identifying the CYP2C19 variants and 100% agreement in classifying the patients as extensive (n=59) or reduced metabolisers (n=15). Extensive metabolisers had significantly higher active metabolite exposure than reduced metabolisers (LS means 12.6 ng*h/ml vs 7.7 ng*h/ml; p<0.001). Extensive metabolisers also had lower PRU (LS means 158 vs 212; p=0.003) and VASP PRI (LS means 48% vs 63%, p=0.01) compared to reduced metabolisers. Rates of high on-treatment platelet reactivity were higher in reduced metabolisers compared to extensive metabolisers (VASP PRI ≥50%: 79% vs 47%; PRU >235: 33% vs 16%). The Nanosphere Verigene CBS system identified 11 CYP2C19 alleles in less than 3 hours with a high degree of accuracy when compared to a conventional method, and was further validated against pharmacokinetic and pharmacodynamic phenotypes.