600,000 angioplasties are performed every year in the United States, which has raised the question of which antiplatelet medication is best after a coronary stent. Looking to individual’s genome is where the Center for Individualized Medicine is studying, with their newly launched TAILOR-PCI study. This study examines the CYP2C19 genotype of a patient to determine if heart medication will help prevent heart attack, unstable angina, stroke and cardiovascular death in patients who undergo percutaneous coronary interventions.
“The current standard of care after angioplasty is to prescribe clopidogrel for one year, regardless of a person’s individual genotype, even though we have known for several years that variations in the CYP2C19 gene make it difficult or impossible to benefit from the drug,” says Naveen Pereira, M.D., a Mayo Clinic cardiologist and principal investigator of TAILOR-PCI. “What we don’t know—and why there is such confusion in the cardiovascular community—is how these genetic changes affect long-term outcomes and whether we can decrease overall health care costs.”
The U.S. Food and Drug Administration recently made a recommendation that patients undergo genetic testing before taking Plavix (clopidogrel bisulfate), which does not have its anti-platelet effects until the liver enzyme CYP2C19 metabolizes the drug into its active form. Brilinta (ticagrelor), however, does not require activation through the same genetic pathway and is the alternative medication being tested in TAILOR-PCI.
Study teams at 15 hospitals in three countries, including Mayo Clinic, have teamed up to enroll 6,000 patients into TAILOT-PCI and deliver results in less than 2 years. The study is administered by the Pharmacogenomics Program in the Center for Individualized Medicine.