International Journal of Clinical Pharmacy

, Volume 38, Issue 2, pp 414–420 | Cite as

Comparison of a rapid point-of-care and two laboratory-based CYP2C19*2 genotyping assays for personalisation of antiplatelet therapy

  • Francesca Wirth
  • Graziella Zahra
  • Robert G. Xuereb
  • Christopher Barbara
  • Albert Fenech
  • Lilian M. Azzopardi
Research Article

Abstract

Background A quick CYP2C19*2 genotyping assay can be useful in personalised antiplatelet-therapy. Objective To apply a rapid point-of-care (POC) CYP2C19*2 genotyping assay for personalisation of antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) and to compare this POC assay to two laboratory-based CYP2C19*2 genotyping assays. Setting Cardiac Catheterisation Suite and Molecular Diagnostics Unit in a general hospital. Methods A buccal sample was collected for POC CYP2C19*2 genotyping with the Spartan™ RX system (Spartan Bioscience). A whole blood sample was collected from the same patients for laboratory-based CYP2C19*2 genotyping with a TaqMan® allelic discrimination assay (Life Technologies) using real-time quantitative PCR and with the GenID® reverse dot-blot hybridisation assay (Autoimmun Diagnostika GmbH). Each patient was genotyped as a non-carrier of CYP2C19*2 (*1/*1), a carrier of one CYP2C19*2 allele (*1/*2), or a carrier of two CYP2C19*2 alleles (*2/*2). Genotyping, interpretation and communication of genotype results (*1/*2, *2/*2) to the consultant cardiologist was undertaken by a clinical pharmacist researcher. Quantitative and qualitative comparison between the three assays was carried out. Main outcome measures Application of a rapid POC CYP2C19*2 genotyping assay for antiplatelet therapy individualisation; comparison of the POC CYP2C19*2 genotyping assay to two laboratory-based assays. Results The total sample consisted of 34 Caucasian patients. With the POC assay, 21 patients were genotyped as non-carriers of CYP2C19*2, 12 patients as carriers of one CYP2C19*2 allele and one patient as a carrier of two CYP2C19*2 alleles. With both laboratory-based assays, the same 21 patients were genotyped as non-carriers of CYP2C19*2, however 13 patients were genotyped as carriers of one CYP2C19*2 allele and no patients were genotyped as carriers of two CYP2C19*2 alleles. Agreement in genotype results was 97 % (κ = 0.939) between the POC assay and both laboratory-based assays and 100 % (κ = 1.000) between the two laboratory-based assays. Conclusion Compared to both laboratory-based genotyping assays, the POC assay is accurate and reliable, provides rapid results, can process single samples, is portable and more operator-friendly, however the tests are more expensive.

Keywords

Antiplatelet therapy CYP2C19*2 genotyping Malta Percutaneous coronary intervention Personalised medicine Point-of-care 

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Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  1. 1.Department of Pharmacy, Faculty of Medicine and SurgeryUniversity of MaltaMsidaMalta
  2. 2.Molecular Diagnostics Unit, Department of PathologyMater Dei HospitalMsidaMalta
  3. 3.Cardiac Catheterisation Suite, Department of CardiologyMater Dei HospitalMsidaMalta

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