Read on below to catch up on the latest developments in Pharmacogenomics, including CYP2C19 Testing for Clopidogrel use, the Great North Pharmacy Research Collaborative, an Introduction to Person-Centred Consultations, our upcoming Pharmacogenomics Podcast episode, and more!
CYP2C19 Pharmacogenomic Testing to guide Clopidogrel use following a Stroke
Clopidogrel is an antiplatelet medicine which prevents abnormal clotting in the arteries by telling platelets not to stick together and form a blood clot. Clopidogrel is commonly prescribed after ischaemic strokes or transient ischaemic attacks.
Clopidogrel is a ‘pro-drug’. This means the drug must be metabolised into an active form in the liver to be effective. The enzyme CYP2C19 is especially important in this process and is coded for by a gene called CYP2C19 (see Fig. 1).
Fig. 1. Clopidogrel metabolism. Reference – Using pharmacogenomics to improve patient outcomes. A report from the Royal College of Physicians and British Pharmacological Society joint working party (2022).
Some people have CYP2C19 gene variants that lead to decreased enzyme activity (known as ‘loss of function’ or ‘no function’ variants), this means clopidogrel metabolism via the CYP2C19 enzyme may be less effective and clopidogrel may not work as well in these people.
The evidence for CYP2C19 genotype testing to guide clopidogrel use in neurovascular conditions such as stroke is mounting. On 31 July 2024, NICE published their diagnostics guidance for CYP2C19 genotype testing to guide clopidogrel use after ischaemic stroke or transient ischaemic attack.
Key Facts
- In the UK, it is estimated that 100,000 people have a stroke every year. The most common type of stroke is ischaemic stroke, they happen when a blood clot blocks the flow of blood and oxygen to the brain.
- NICE recommends CYP2C19 genotype testing if treatment with clopidogrel is being considered.
- Approximately 30% of people in the UK (and this can be higher in different ethnic groups) have a change in the CYP2C19 gene which reduces clopidogrel’s effectiveness.
So, what does this mean in practice?
Currently, there is no NHS laboratory-based genotype testing for CYP2C19 in England. NICE is therefore working with NHS England to deliver a national pilot to inform future implementation of CYP2C19 testing in stroke. The NHS England pilot is at an early stage and we will keep you updated as information becomes available.
Helpful resources for clinicians:
Great North Pharmacy Research Collaborative
Members of the NEY GMS team attended the annual Great North Pharmacy Research Collaborative Conference in July including Emma Groves, Pharmacy Lead, and Kay Cawthorn, Lead Nurse.
Said Emma of the event, “It was brilliant to connect with foundation pharmacists and pharmacy professionals from hospital, community and primary care teams and spread the word about genomics and how it’s relevant to pharmacy!”
Learn more about pharmacogenomics at Medicines Learning Portal: PGx
Genomics in Pharmacy: an introduction to person-centred consultations
The Centre for Pharmacy Postgraduate Education recently launched a new e-learning programme for pharmacy professionals: Genomics in pharmacy: an introduction to person-centred consultations. Topics include factors to consider, how to respond appropriately to questions and where to signpost people for extra support. View course details here
Pharmacogenomics Lunch & Learn – watch it back!
Our recent Lunch & Learn webinar, ‘A Beginner’s Guide to Pharmacogenomics’ is now available to watch on demand. The ‘packed’ webinar was very well attended and gave everyone an opportunity to explore how a person’s genomic information can impact how they respond to medicines.
The session introduced participants to key pharmacogenomics concepts, highlighted real-world examples in clinical practice and tested their knowledge with interactive polls. Watch it back here.
Pharmacogenomics NHS Genomic Network of Excellence Event
An informative and engaging event about Pharmacogenomics is planned on 17th October 2024 in London (Hallam Conference Centre). The agenda includes an overview of the Network, a patient perspective on pharmacogenomics (PGx) and specialised workshops focusing on Paediatric PGx, Mental Health PGx and Cancer PGx as well as discussions and networking opportunities.
For more information and registration details, see NHS PGx GNoE Event
Pharmacogenomics Podcast
Make a note in your diary! On Monday 23rd September @ 6am, the second episode of Series 3 (of #TheRoadToGenome) drops and is all about pharmacogenomics! It’s a fascinating and insightful interview with our very own Pharmacy Lead, Emma Groves, revealing how genomic testing is transforming the way we prescribe and administer medicines, tailored to the individual, optimising safety and efficacy for our patients! Listen on your podcast app or @ The Road to Genome