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AuthorAlMukdad, Sawsan
AuthorElewa, Hazem
AuthorAl-Badriyeh, Daoud
Available date2020-04-06T07:04:32Z
Publication Date2020
Publication NameJournal of Cardiovascular Pharmacology and Therapeutics
Identifierhttp://dx.doi.org/10.1177/1074248420902298
CitationAlMukdad, S., Elewa, H., & Al-Badriyeh, D. (2020). Economic Evaluations of CYP2C19 Genotype-Guided Antiplatelet Therapy Compared to the Universal Use of Antiplatelets in Patients With Acute Coronary Syndrome: A Systematic Review. Journal of Cardiovascular Pharmacology and Therapeutics, 25(3), 201–211. https://doi.org/10.1177/1074248420902298
ISSN1074-2484
URIhttp://hdl.handle.net/10576/13851
AbstractClopidogrel is widely used after the percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) and requires activation by cytochrome P450 (CYP), primarily CYP2C19. Patients with CYP2C19 loss-of-function alleles are at increased risk of major adverse cardiovascular events, while more expensive novel antiplatelet agents (ticagrelor and prasugrel) are unaffected by the CYP2C19 mutations. This systematic review aims to answer the question about whether overall evidence supports the genotype-guided selection of antiplatelet therapy as a cost-effective strategy in post-PCI ACS. A systematic literature search of PubMed, EMBASE, EconLit, and PharmGKB was done to identify all the economic evaluations related to genotype-guided therapy compared to the universal use of antiplatelets in ACS patients. Quality of Health Economic Studies tool was used for quality assessment. The search identified 13 articles, where genotype-guided treatment was compared to universal clopidogrel, ticagrelor, and/or prasugrel. Six studies showed that genotype-guided therapy was cost-effective compared to universal clopidogrel, while 5 studies showed that it was dominant. One study specified that genotype-guided with ticagrelor is cost-effective only in both CYP2C19 intermediate and poor metabolizers. Genotype-guided therapy was dominant when compared to universal prasugrel, ticagrelor, or both in 5, 1, and 3 studies, respectively. Only 2 studies reported that universal ticagrelor was cost-effective compared to genotype-guided treatment. All the included articles had good quality. Based on current economic evaluations in the literature, implementing CYP2C19 genotype-guided therapy is a cost-effective approach in guiding the selection of medication in patients with ACS undergoing PCI.
Languageen
PublisherSAGE Publications
SubjectCYP2C19 genotype
clopidogrel
cost-effectiveness
percutaneous coronary intervention
prasugrel
ticagrelor
TitleEconomic Evaluations of CYP2C19 Genotype-Guided Antiplatelet Therapy Compared to the Universal Use of Antiplatelets in Patients With Acute Coronary Syndrome: A Systematic Review.
TypeArticle
Pagination201-211
Issue Number3
Volume Number25
ESSN1940-4034
dc.accessType Abstract Only


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