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Nuñez-Medina H, Monero M, Torres LM, Leal E, González-Sepúlveda L, Mayor ÁM, Renta JY, González-García ER, González A, Melin K, Scott SA, Ruaño G, Hernandez-Suarez DF, Duconge J. Implementing a Pharmacogenomic-driven Algorithm to Guide Antiplatelet Therapy among Caribbean Hispanics: A non-randomized prospective cohort study. medRxiv 2023:2023.12.05.23299547. [PMID: 38106133 PMCID: PMC10723501 DOI: 10.1101/2023.12.05.23299547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background After percutaneous coronary intervention (PCI), clopidogrel resistant patients are at an increased risk of major adverse cardiovascular and cerebrovascular events (MACCEs). We aimed to assess whether genotype-guided selection of oral antiplatelet drugs using a clinical decision support (CDS) algorithm reduces the occurrence of these ischemic events and improves outcomes among Caribbean Hispanic patients from Puerto Rico, who are underrepresented in clinical pharmacogenomic (PGx)-guided implementation studies. Methods Individual platelet function testing (PRU) measures, CYP2C19*2 and PON1 rs662 genotypes, clinical and demographic data from 8 medical facilities were included. Patients were separated into standard of care (SoC) and genotype-guided groups (150 each). Risk scores were calculated based on a previously developed CDS risk prediction algorithm designed to make actionable treatment recommendations for each patient. Alternative therapy with ticagrelor was recommended for patients with a high risk score ≥2. Statistical associations between patient time free of MACCEs and predictor variables (i.e., treatment groups, risk scores) were tested in this population using Kaplan-Meier survival analyses and Cox proportional-hazards regression models. Results Median age of participants is 67 years; BMI: 27.8; 48% women; 14% smokers; 59% with type-2 diabetes mellitus (T2DM). Among patients with high-risk scores who were free from MACCE events 6 months after coronary stenting, genotype-driven guidance of antiplatelet therapy showed superiority over SoC in terms of reducing the incidence rate of atherothrombotic events. Conclusions The clinical utility of our PGx-driven CDS algorithm to reduce the incidence rate of MACCEs among post-PCI Caribbean Hispanic patients on clopidogrel was externally demonstrated. Clinical Trial Registration Unique Identifier NCT03419325.
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Affiliation(s)
- Héctor Nuñez-Medina
- Division of Cardiovascular Medicine, University of Puerto Rico - Medical Sciences Campus, School of Medicine, San Juan, Puerto Rico, United States
| | - Mariangeli Monero
- Department of Pharmacology, School of Medicine, University of Puerto Rico - Medical Sciences Campus, San Juan, Puerto Rico, 00936, United States
| | - Lorna M Torres
- Division of Cardiovascular Medicine, University of Puerto Rico - Medical Sciences Campus, School of Medicine, San Juan, Puerto Rico, United States
| | - Enrique Leal
- Division of Cardiovascular Medicine, University of Puerto Rico - Medical Sciences Campus, School of Medicine, San Juan, Puerto Rico, United States
| | - Lorena González-Sepúlveda
- Biostatistics, Epidemiology, and Research Design Core. Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico - Medical Sciences Campus, San Juan, Puerto Rico, 00936, United States
| | - Ángel M Mayor
- Biostatistics, Epidemiology, and Research Design Core. Hispanic Alliance for Clinical and Translational Research, University of Puerto Rico - Medical Sciences Campus, San Juan, Puerto Rico, 00936, United States
| | - Jessicca Y Renta
- Research Centers in Minority Institutions (RCMI) Program, Center for Collaborative Research in Health Disparities (CCRHD), University of Puerto Rico - Medical Sciences Campus, San Juan, Puerto Rico, 00936, United States
| | - Edgardo R González-García
- Research Centers in Minority Institutions (RCMI) Program, Center for Collaborative Research in Health Disparities (CCRHD), University of Puerto Rico - Medical Sciences Campus, San Juan, Puerto Rico, 00936, United States
| | - Ariel González
- Division of Cardiovascular Medicine, University of Puerto Rico - Medical Sciences Campus, School of Medicine, San Juan, Puerto Rico, United States
| | - Kyle Melin
- Department of Pharmaceutical Sciences and Pharmacy Practice, School of Pharmacy, University of Puerto Rico - Medical Sciences Campus, San Juan, Puerto Rico, 00936, United States
| | - Stuart A Scott
- Department of Pathology, Stanford University, Palo Alto, CA 94304, United States
| | - Gualberto Ruaño
- Institute of Living at Hartford Hospital; Hartford, CT 06102, USA
| | | | - Jorge Duconge
- Department of Pharmaceutical Sciences and Pharmacy Practice, School of Pharmacy, University of Puerto Rico - Medical Sciences Campus, San Juan, Puerto Rico, 00936, United States
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