Challenges and prospects of CYP2C19 genotype-guided clopidogrel therapy from the perspective of precision medicine

CYP2C19 (*2, *3, *17 — clopidogrel)

Systematic review of randomized trials (TAILOR-PCI, POPular Genetics, PHARMCLO) and meta-analyses on CYP2C19 genotyping for clopidogrel; analysis of polygenicity (ABCB1, CES1, PON1) and allele frequency differences between populations

Systematic review analyzing data from major trials on CYP2C19 genotyping for clopidogrel post-PCI. Heterogeneity across trials (TAILOR-PCI negative at 12 months, positive Asian meta-analyses with -31% MACE) reflects allele frequency differences between populations (CYP2C19*2: ~15% in Europe vs ~30% in East Asia). The review also examines lesser-known alleles (ABCB1, CES1), point-of-care testing strategy, and predictive value of platelet function tests as complement.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

The core of the clopidogrel/CYP2C19 debate comes down to allele frequency differences between populations: testing is more useful in Asian than European populations. In the French context (CYP2C19*2 ~15%), selecting high-thrombotic-risk patients (ACS, active stent) remains the most cost-effective strategy.

CPIC Level A / FDA black box +2; synthesis of divergent trials +2; Asian vs European populations perspective +2; Front Pharmacol +1