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Qiu X, Zhang Y, Gu H, Jiang Y, Pan Y, Jiang Y, Meng X, Wang Y, Zhao X, Li H, Wang X, Wang Y, Li Z. Association Between CYP2B6 Polymorphisms and Efficacy of Clopidogrel in Minor Stroke or Transient Ischemic Attack. Stroke 2023. [PMID: 37264909 DOI: 10.1161/strokeaha.122.040507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND CYP2B6 (cytochrome P450 subfamily IIB polypeptide 6), encoded by the CYP2B6 gene, is a critical enzyme involved in clopidogrel metabolism. However, the association between CYP2B6 polymorphisms and the efficacy of clopidogrel in minor stroke or transient ischemic attack for secondary stroke prevention remains unclear. METHODS Based on CHANCE (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) randomized clinical trial of aspirin plus clopidogrel versus aspirin alone, we investigated the role of CYP2B6 polymorphisms and the efficacy of clopidogrel in patients with minor stroke or transient ischemic attack in China from October 2009 to July 2012. A total of 2853 patients were successfully genotyped for CYP2B6-516G>T, rs3745274 and CYP2B6-1456 T>C, rs2054675. The primary efficacy and safety outcomes were new stroke and any bleeding within 90 days. RESULTS Among the 2853 patients, 32.8% were identified as the carriers of the CYP2B6-516 GT/TT or -1456 TC/CC genotype. The incidences of 90-day new stroke in aspirin plus clopidogrel and aspirin alone groups were 7.1% versus 11.3% among noncarriers, respectively; and 9.7% versus 12.2% among carriers, respectively. The efficacy of aspirin plus clopidogrel versus aspirin alone was not significantly different (P interaction=0.29) in noncarriers (adjusted hazard ratio, 0.61 [95% CI, 0.45-0.83]) compared to carriers (adjusted hazard ratio, 0.80 [95% CI, 0.54-1.18]). The incidence (n=51) of 90-day any bleeding in aspirin plus clopidogrel and aspirin alone groups were 2.2% (21 bleeds) versus 1.9% (18 bleeds) among noncarriers (adjusted hazard ratio, 1.11 [95% CI, 0.59-2.09]) and 1.9% (9 bleeds) versus 0.7% (3 bleeds) among carriers (adjusted hazard ratio, 3.23 [95% CI, 0.86-12.12]). Similar findings were observed during the 1-year follow-up. CONCLUSIONS In this post hoc analysis of the CHANCE trial, we did not observe a significant difference in the efficacy of aspirin plus clopidogrel compared with aspirin in carriers versus noncarriers of CYP2B6-516 GT/TT or -1456 TC/CC genotype. Our results suggest that both carriers and noncarriers suffering from a minor stroke are likely to benefit from aspirin plus clopidogrel treatment over aspirin monotherapy for secondary prevention. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT00979589.
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Affiliation(s)
- Xin Qiu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.Q., H.G., Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- China National Clinical Research Center for Neurological Diseases, Beijing (X.Q., H.G., Yingyu Jiang, Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
| | - Yongbo Zhang
- Key Laboratory of Genetic Networks, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Shanghai. (Y.Z., X.W.)
| | - Hongqiu Gu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.Q., H.G., Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- China National Clinical Research Center for Neurological Diseases, Beijing (X.Q., H.G., Yingyu Jiang, Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
| | - Yingyu Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing (X.Q., H.G., Yingyu Jiang, Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.Q., H.G., Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- China National Clinical Research Center for Neurological Diseases, Beijing (X.Q., H.G., Yingyu Jiang, Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.Q., H.G., Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- China National Clinical Research Center for Neurological Diseases, Beijing (X.Q., H.G., Yingyu Jiang, Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.Q., H.G., Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- China National Clinical Research Center for Neurological Diseases, Beijing (X.Q., H.G., Yingyu Jiang, Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.Q., H.G., Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- China National Clinical Research Center for Neurological Diseases, Beijing (X.Q., H.G., Yingyu Jiang, Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.Q., H.G., Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- China National Clinical Research Center for Neurological Diseases, Beijing (X.Q., H.G., Yingyu Jiang, Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.Q., H.G., Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- China National Clinical Research Center for Neurological Diseases, Beijing (X.Q., H.G., Yingyu Jiang, Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
| | - Xiujie Wang
- Key Laboratory of Genetic Networks, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Shanghai. (Y.Z., X.W.)
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.Q., H.G., Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- China National Clinical Research Center for Neurological Diseases, Beijing (X.Q., H.G., Yingyu Jiang, Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing (Yongjun Wang, Z.L.)
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai.(Yongjun Wang)
- Clinical Center for Precision Medicine in Stroke, Capital Medical University, Beijing, China (Yongjun Wang)
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.Q., H.G., Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- China National Clinical Research Center for Neurological Diseases, Beijing (X.Q., H.G., Yingyu Jiang, Y.P., Yong Jiang, X.M., Yilong Wang, X.Z., H.L., Yongjun Wang, Z.L.)
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing (Yongjun Wang, Z.L.)
- Chinese Institute for Brain Research, Beijing, China (Z.L.)
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