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ELEVATE-TIMI 56 trial - Summary & Results

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http://www.theheart.org/web_slides/1352489.do

A study on ELEVATE-TIMI 56 to determine whether higher as compared with lower maintenance doses of clopidogrel can adequately improve the degree of platelet inhibition in carriers of a reduced-function CYP2C19 allele.

Publicado en: Salud y medicina, Tecnología
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ELEVATE-TIMI 56 trial - Summary & Results

  1. 1. ELEVATE-TIMI 56 (Escalating Clopidogrelby Involving a Genetic Strategy -Thrombolysis in MI 56)
  2. 2. ELEVATE-TIMI 56 (Escalating Clopidogrel by Involving aGenetic Strategy - Thrombolysis in MI 56)J Mega (Brigham and Womens Hospital, Boston, MA)American Heart Association 2011 Scientific Sessions• A study to determine whether higher as compared with lower maintenance doses of clopidogrel can adequately improve the degree of platelet inhibition in carriers of a reduced-function CYP2C19 allele• Population and treatment: 333 patients genotyped Noncarriers of the loss-of-function CYP2C19*2 allele received clopidogrel doses of 75 mg and 150 mg daily (two 14-day treatment periods each) Carriers (heterozygotes and homozygotes) received doses of 75 mg, 150 mg, 225 mg, and 300 mg daily for four 14-day treatment periods Platelet-function testing was performed with VASP and VerifyNow assays• Primary end point: Change in measurements of platelet inhibition
  3. 3. ELEVATE-TIMI 56: Results• CYP2C19*2 carriersa had significantly higher on-treatment platelet reactivity than did noncarriers with a standard clopidogrel maintenance dose of 75 mg dailyEffect of clopidogrel dose and loss-of-function genotype on PRI (VASP) Group 75 mg 150 mg 225 mg 300 mg p Noncarriers 57.5 46.9 — — <0.001 CYP2C19*2 heterozygotes 70.0 61.4 52.7 48.9 <0.001 CYP2C19*2 homozygotes 86.6 77.8 73.0 68.3 0.003Effect of clopidogrel dose and loss-of-function genotype on PRI (VerifyNow) Group 75 mg 150 mg 225 mg 300 mg p Noncarriers 163.6 126.7 — — <0.001 CYP2C19*2 heterozygotes 225.6 188.1 152.9 127.5 <0.001 CYP2C19*2 homozygotes 328.8 310.2 286 287.0 0.32a Includes both heterozygotes and homozygotesPRI=platelet-reactivity index
  4. 4. ELEVATE-TIMI 56: Commentary*"This means we can work with clopidogrel in the vast majority of patients." - Dr Jessica Mega"If I were a patient, Id very much want this genetic test if I were going on Plavixtoday. And I would work with my physician to make a personal decision." - Dr Lawrence J Lesko"This is quite a novel and impressive study. . . . All of this reinforces the need toknow genotype in patients at risk, such as those with stent implantation." - Dr Eric Topol*All comments from ELEVATE-TIMI 56: Clopidogrel 225 mg for patients with one loss-of-function allele(http://www.theheart.org/article/1312759.do)
  5. 5. Become a member of http://www.theheart.org Become a fan on Facebook: http://www.facebook.com/theheartorg Follow us on Twitter: http://www.twitter.com/theheartorgtheheart.org is the leading online source of independent cardiology news.We are the top provider of news and opinions for over 100 000 physicians.

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