title: A risk-benefit assessment of prasugrel, clopidogrel, and genotype-guided therapy in patients undergoing percutaneous coronary intervention.
abstract: 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.
authors.affiliation: Institute for Public Health Genetics, University of Washington, Seattle, WA, USA.
authors.forename: G F
authors.initials: GF
authors.lastname: Guzauskas
authors.forename: D A
authors.initials: DA
authors.lastname: Hughes
authors.forename: S M
authors.initials: SM
authors.lastname: Bradley
authors.forename: D L
authors.initials: DL
authors.lastname: Veenstra
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics*; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D011336:Probability; D018570:Risk Assessment; D013876:Thiophenes / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine