Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Efficacy of Clopidogrel for Stroke Depends on CYP2C19 Genotype and Risk Profile
First author：Xu Jie,Wang Anxin,Wangqin Runqi
Corresponding author：Wang Yongjun
essential_information
- Person in charge：Xu Jie,Wang Anxin,Wangqin Runqi
- Data Sources： CHANCE
- Number of papers：OTHERS20190773
- Published time：2019-06-25
2019-06-25
Published articles
Journal：Annals of neurology
Publication type: Research Article
IF(IF): 10.422
PMID: 31237713 Link To Pubmed Full text Download
Background And Purpose
Method
CYP2C19 loss-of-function allele (LoFA) carriers were defined as patients with either LoFA of *2 or *3. Low and high risk profile was defined as Essen stroke risk score (ESRS)<3 and ≥3, respectively. Stroke recurrence at one year was defined as primary outcome.
Conclusion
Overall LoFA carriers do not benefit from DAT, but there is significant benefit for LoFA carriers who are at high risk. The benefit of clopidogrel in Chinese MS/TIA patients depends on CYP2C19 genotype and risk profile.
Main results
In total 2933 MS/TIA patients, there were 1726 (58.8%) LoFA carriers and 1068 (36.4%) patients at high risk (ESRS≥3). No significant difference for stroke recurrence between clopidogrel-aspirin group and aspirin alone group was found in LoFA carriers (11.2% vs 13.3%, HR, 0.83; 95% CI, 0.64~1.09). In Stratified analyses by CYP2C19 genotype and ESRS, HRs (95% CIs) of the clopidogrel-aspirin therapy for stroke recurrence were 1.00 (0.70~1.42), 0.63 (0.41~0.97), 0.62 (0.40~0.96) and 0.52 (0.31~0.88) among subgroups of LoFA carriers at low risk, LoFA carriers at high risk, LoFA non-carriers at low risk and LoFA non-carriers at high risk, respectively, with p=0.021 for interaction.