A blood thinner is often the drug of choice for coronary heart disease or after a heart attack. Unfortunately, the drug clopidogrel, which is used very frequently, does not work in the same way for everyone patients . Pharmacogenetic tests provide certainty here or show possible more effective alternatives.
Pharmacogenetics is particularly relevant for clopidogrel, a drug used to prevent blood clots. Clopidogrel is a prodrug that has to be metabolized into its active form in the body. Some people have genetic variants that impair their ability to metabolize clopidogrel, which can lead to reduced efficacy or ineffectiveness of the drug. Pharmacogenetics can help to identify these patients , prescribe an adjusted dose or offer an alternative therapy to achieve the therapeutic goal of reducing the risk of a heart attack or stroke.
Thus, the advantages of pharmacogenetics in clopidogrel lie in the ability to provide personalized therapy tailored to the genetic characteristics of the individual. This can help maximize the efficacy of treatment and minimize the risk of side effects.
CYP2C19 is an important enzyme involved in the metabolization of various drugs, including clopidogrel. Genetic variations in CYP2C19 can affect the activity of this enzyme and thus the efficacy of drugs metabolized by this enzyme. There are several known genetic variants of CYP2C19 that can lead to different metabolic phenotypes. The intermediate metabolizer (IM) and poor metabolizer (PM) phenotypes are particularly relevant. Intermediate metabolizers (IM) have reduced enzymatic activity due to one or more variants in CYP2C19. In the case of clopidogrel, this means that it cannot be sufficiently converted into the active ingredient.
Poor metabolizers (PM) have little to no enzymatic activity due to two non-functional alleles, which prevents conversion into the active substance. The frequency of these gene variants varies greatly between different ethnic groups. About 2-15% of the population are Poor Metabolizers, while the frequency of Intermediate Metabolizers is significantly higher.
