The Use of Genetics in Guiding Therapy

Clopidogrel (Plavix)

June 2012

Clopidogrel, or Plavix, is a commonly used anti-platelet drug which is administered as an inactive prodrug and metabolized to its active form by CYP or cytochrome P450 enzymes. It is used to reduce atherosclerotic events in patients with acute coronary syndrome and/or following Percutaneous Coronary Intervention or PCI. It is often given as alternative to aspirin or in combination with aspirin which is known as dual antiplatelet therapy. There is a highly variable response to clopidogrel where it is efficacious in some, and not efficacious in others. This can be due to many variables including underdosing and interactions with CYP inhibitors and substrates, as well as genetics.

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Clopidogrel (Plavix)

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• Introduction
• Pharmacogenomics
• PGx Biomarkers in Drug Labels
• FDA-Approved Drugs with PGx-Related Label Information
• FDA-Approved Drugs with PGx-Related Label Information
• The FDA and PGx-Related Drug Label Updates
• Clopidogrel (Plavix)
• CYP2C19 and Response to Clopidogrel
• CYP2C19 and Response to Clopidogrel (cont)
• CYP2C19 PGx Testing for Clopidogrel
• Mayo CYP2C19 Test
• The FDA and PGx-Related Drug Label Updates
• Warfarin
• Warfarin PGx
• Allele Frequencies
• Medco-Mayo Warfarin Effectiveness Study
• Mayo Test for Warfarin Sensitivity
• FDA-Approved Drugs with PGx-Related Label Information
• Most Psychotropic Medications Are Metabolized by CYPs
• CYP450 Testing — Psychotherapeutics
• CYP2D6
• Mayo Test for CYP2D6
• Mayo Tests for CYP2D6
• Additional Mayo Tests for Psychiatric Applications
• The FDA and PGx-Related Drug Label Updates
• UGT1A1
• Irinotecan Metabolism
• UGT1A1 Genetic Variants
• Mayo Tests for UGT1A1
• The FDA and PGx-Related Drug Label Updates
• Human Leukocyte Antigens and Drug Hypersensitivity
• HLA-B*1502
• Mayo Test for HLA-B*1502
• HLA-B*5701
• Mayo Test for HLA-B*5701
• Summary
• Questions