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A Risk–Benefit Assessment of Prasugrel, Clopidogrel, and Genotype‐Guided Therapy in Patients Undergoing Percutaneous Coronary Intervention
Author(s) -
Guzauskas G F,
Hughes D A,
Bradley S M,
Veenstra D L
Publication year - 2012
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1038/clpt.2011.303
Subject(s) - prasugrel , clopidogrel , medicine , cyp2c19 , percutaneous coronary intervention , acute coronary syndrome , conventional pci , cardiology , intensive care medicine , aspirin , myocardial infarction , cytochrome p450 , metabolism
The objective of this study was to quantitatively evaluate the clinical benefits and harms of prasugrel, clopidogrel, and a CYP2C19 genotype‐guided drug selection strategy for patients with acute coronary syndrome (ACS) and planned percutaneous coronary intervention (PCI). We used decision‐analytic techniques to model the risks and benefits of alternative antiplatelet strategies. Sensitivity and scenario analyses were conducted to assess the uncertainty of the results. Prasugrel demonstrated little difference in net benefit as compared with clopidogrel (+0.02 quality‐adjusted life‐years (QALYs); 95% confidence range (CR), −0.23 to 0.21). The genotype‐guided strategy had a 93% probability of greater net benefit as compared with clopidogrel (+0.05 QALYs; 95% CR, −0.02 to 0.11), and 66% probability of greater net benefit as compared with prasugrel (+0.03 QALYs; 95% CR, −0.13 to 0.24). Prasugrel and clopidogrel differ in their risk–benefit profiles but appear to offer similar net benefit on average. Use of patient‐specific factors such as CYP2C19 genotype offers promise for developing a personalized medicine approach to antiplatelet treatment regimens. Clinical Pharmacology & Therapeutics (2012); 91 5, 829–837. doi: 10.1038/clpt.2011.303