Bedside Testing of CYP2C19 Gene for Treatment of Patients With PCI With Antiplatelet Therapy

January 20, 2016 updated by: Imam Abdulrahman Bin Faisal University

Bedside Testing of the CYP2C19 Gene to Asses Effectiveness of Clopidogrel in Coronary Artery Disease Patients Treated With Percutaneous Coronary Intervention : Individualized Antiplatelet Drugs Treatment to Improve Prognosis

Clopidogrel is crucial as antiplatelet treatment in patients undergoing percutaneous coronary intervention (PCI) with stent implantation and during one year after PCI, to prevent atherothrombotic complications. However, clopidogrel is ineffective in certain patients due to genetic mutation in CYP2C19 gene a specific enzyme in the liver required for metabolism of clopidogrel. Therefore, the purpose of this study is to test these patients genetically at bedside and prescribe an alternative drug such as Ticagrelor (90 mg twice daily) or prasugrel ( 10mg once daily or 5mg once daily if the patient older than 75 years or a body weight < 60kg) if they are carriers of the allele 2 or 3 of the mutated gene.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

Clopidogrel is crucial as antiplatelet treatment in patients undergoing percutaneous coronary intervention (PCI) with stent implantation and during one year after PCI, to prevent atherothrombotic complications. Clopidogrel is converted into its active metabolite by Cytochrome P2C19 (CYP2C19). However 30 % of the Saudi population is carrier of the non functional CYP2C19*2 or *3 alleles having an impaired CYP2C19 capacity, resulting in decreased effectiveness of Clopidogrel. These patients have a 42% higher risk for major cardiovascular events (MACE) compared to non carriers. Further 50 % of the MACE occurs in the first 48 hours. Therefore Ticagrelor (90 mg twice daily) or prasugrel ( 10mg once daily or 5mg once daily if the patient older than 75 years or a body weight < 60kg) whose actions are not dependent on conversion by CYP2C19 may be an alternative only in carriers of the non functional CYP2C19*2 or *3 alleles. This might be cost effective and prevent patients form MACE. Therefore the objective of this study is to assess the efficacy, complication free survival, safety and cost-effectiveness of the CYP2C19 genotype guided antiplatelet treatment strategy, using clopidogrel or prasugrel (or Ticlid). All participants will be followed for one year using follow up questionnaires.

Study Type

Interventional

Enrollment (Anticipated)

1500

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Saudi Arabia
      • Al-Hasa, Saudi Arabia, 31982
        • Recruiting
        • Prince Sultan Cardiac Center
        • Sub-Investigator:
          • Abdullah Alabdulgader, MD
      • Al-Khobar, Saudi Arabia, 31441
        • Recruiting
        • King Fahd University Hospital
        • Principal Investigator:
          • Abdullah M Al-Rubaish, MD
        • Sub-Investigator:
          • Fahd A Al-Muhanna, MD
        • Sub-Investigator:
          • Emmanuel Larbi, MD, PhD
        • Sub-Investigator:
          • Abdullah Al-Shehri, MD
        • Sub-Investigator:
          • Akram Al-Khadra, MD
        • Sub-Investigator:
          • Amein Al-Ali, PhD
        • Sub-Investigator:
          • Mohammed Al-Mansory, MD
      • Dammam, Saudi Arabia, 31463
        • Recruiting
        • Saud Al-Babtain Cardiac Center
        • Sub-Investigator:
          • Hamid Al-Omran, MD
        • Sub-Investigator:
          • Mustafa Al-Refaei, MD
        • Sub-Investigator:
          • Najeeb Abdulhamid, MD
        • Sub-Investigator:
          • Shukry Mirza, MD
        • Sub-Investigator:
          • Yousef Alsabeet, MD
      • Dammam, Saudi Arabia, 31932
        • Recruiting
        • King Fahd Military Medical Complex
        • Sub-Investigator:
          • Khalid Al-Fraiedi, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 70 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Male & female age 18-70 years

Inclusion Criteria:

  • Patient presents with acute myocardial infarction of more than 30 minutes and less than 12 hours
  • Patient eligible for PCI

Exclusion Criteria:

  • Life expectancy of less than one year
  • Previously Known genotype
  • Receiving chemotherapy for malignancy
  • On dialysis or receiving immunosuppressive therapy or have autoimmune disease
  • Hepatic impairment
  • History of bleeding diathesis
  • Receiving vitamin K antagonist therapy
  • Confirmed hypertension
  • Out of normal range platelet count
  • History of major surgery
  • Severe trauma or fracture
  • Pregnancy and lactation
  • Concomitant use of simvastatin, cytochrome P450 3A4 inhibitors or inducers
  • Hypersensitivity to clopidogrel or ticagrelor or prasugrel

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Clopidogrel
CYP2C19 genotyping will be carried out at the end of the study period. Clopidogrel will be used for treatment for one year according to local protocol. Patients will receive clopidogrel 75 mg per day.
Drug: clopidogrel
Genotyping will be carried out using Spartan genotyping System on all intervention group and those patients who do not carry the CYP2C19 allele 2 or 3 will be given clopidogrel (75 mg per day) while all patients who carry the CYP2C19 allele 2 or 3 will be prescribed Ticagrelor (90 mg twice daily) or prasugrel ( 10mg once daily or 5mg once daily if the patient older than 75 years or a body weight < 60kg) according to local protocol.
Other Names:
  • Clavix
Experimental: Ticagrelor or prasugrel
Ticagrelor (90 mg twice daily) or prasugrel ( 10mg once daily or 5mg once daily if the patient older than 75 years or a body weight < 60kg) according to local protocol.
Drug: Ticagrelor or prasugrel
ticagrelor (90 mg twice daily) or prasugrel ( 10mg once daily or 5mg once daily if the patient older than 75 years or a body weight < 60kg) according to local protocol.
Other Names:
  • Brilinta
  • Prasuvas

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
cardiovascular event
Time Frame: 1 year
The primary end point is the number of patients who develop adverse major cardiovascular event which include recurrent myocardial infarction, non-fatal stroke, cardiovascular mortality, severe ischemia, major bleeding at 30days after PCI.
1 year

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Mortality
Time Frame: 30 days and 1 year
Secondary efficacy endpoints are the number of patients who either died , died from cardiovascular death, from cerebrovascular death, developed recurrent MI, stent thrombosis, underwent urgent target vessel revascularization, developed stroke or combination of above
30 days and 1 year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Imam Abdulrahman Bin Faisal University

Collaborators

King Fahad Armed Forces Hospital
Dammam Central Hospital

Investigators

  • Principal Investigator: Abdullah M Al-Rubaish, MD, Imam Abdulrahman Bin Faisal University
  • Study Director: Amein K Al-Ali, PhD, Imam Abdulrahman Bin Faisal University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

March 1, 2013

Primary Completion (Anticipated)

January 1, 2016

Study Completion (Anticipated)

March 1, 2016

Study Registration Dates

First Submitted

March 19, 2013

First Submitted That Met QC Criteria

April 2, 2013

First Posted (Estimate)

April 4, 2013

Study Record Updates

Last Update Posted (Estimate)

January 22, 2016

Last Update Submitted That Met QC Criteria

January 20, 2016

Last Verified

January 1, 2016

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • STGUD005

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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