The association of CYP2C19LoF alleles with adverse clinical outcomes in stroke patients taking clopidogrel: An updated meta‐analysis

Author:

Biswas Mohitosh123ORCID,Hossain Md. Shahadat1,Ahmed Rupok Tahsin1,Hossain Md. Sabbir1,Sukasem Chonlaphat2345ORCID

Affiliation:

1. Department of Pharmacy University of Rajshahi Rajshahi Bangladesh

2. Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand

3. Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC) Ramathibodi Hospital Bangkok Thailand

4. Pharmacogenomics and Precision Medicine, The Preventive Genomics & Family Check‐up Services Center, Bumrungrad International Hospital Bangkok Thailand

5. Faculty of Pharmaceutical Sciences Burapha University Saensuk, Mueang Chonburi Thailand

Abstract

AbstractThe aggregated risk of recurrent stroke in stroke/transient ischemic attack (TIA) patients carrying CYP2C19 LoF alleles who take clopidogrel has not been investigated recently, and the available research is limited. This study aimed to perform an updated meta‐analysis to assess the association between CYP2C19 LoF alleles and the risk of recurrent stroke in patients taking clopidogrel. Databases were searched for the literature on eligible studies. The end points were recurrent stroke, composite vascular events, and bleeding events. Odds ratios (ORs) were calculated using RevMan software, where p < 0.05 was considered statistically significant. Patients carrying CYP2C19 LoF alleles who were treated with clopidogrel had a significantly increased risk of recurrent ischemic stroke compared with non‐carriers (OR 2.18, 96% CI 1.80–2.63; p < 0.00001). The risk of recurrent stroke was only significantly different in Asian patients (OR 2.29, 96% CI 1.88–2.80; p < 0.00001) but not in patients of other ethnicities; however, there were a limited number of studies in other ethnic groups. Both observational studies (OR 2.83, 96% CI 2.20–3.65; p < 0.00001) and RCTs (OR 1.48, 96% CI 1.10–1.98; p = 0.009) found associations with a significantly increased risk of recurrent ischemic stroke. Asian stroke patients or TIA patients carrying CYP2C19 LoF alleles and taking clopidogrel were at a significantly higher risk of recurrent ischemic stroke than non‐carriers. Significantly increased risk of recurrent ischemic stroke was found in both observational studies and RCTs.

Publisher

Wiley

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