A genetic test should be carried out on individuals who have had an ischaemic stroke or transient ischaemic attack to establish if they could benefit from taking clopidogrel, according to UK guidance published today.
New draft guidance from the National Institute for Health and Care Excellence, published today, has recommended that clinicians offer laboratory-based genotype testing.
Although NICE recommends clopidogrel for treating people at risk of a secondary stroke, it is not suitable for individuals with certain variations in the CYP2C19 gene because they cannot convert the drug to the active form.
The genotype test, now being recommended, could establish who has these variants so they can be treated with an alternative drug.
If laboratory testing is not possible, NICE said the Genomadix Cube point-of-care test can be used instead.
It is believed that 32% of people in the UK have at least one of the highlighted CYP2C19 gene variants, which are more common in people with an Asian family background.
Evidence has suggested that people with these variants have about a 46% increased risk of another stroke when taking clopidogrel compared to those without them.
If the test establishes an individual has one of the CYP2C19 gene variants, another medicine that prevents blood clots will be offered instead.
Mark Chapman, interim director of medical technology and digital evaluation at NICE, said: “The recommendation is a step forward in ensuring people who have had a stroke receive personalised care thanks to a genetic test run after their DNA is sequenced using their blood or saliva.
“Treatment with clopidogrel is effective in preventing further strokes for the majority of people who don’t have the gene variant. But until now doctors have not known who cannot be treated with clopidogrel until after they’ve had a second stroke or TIA and that could be too late.
“If the CYP2C19 variants are found, other treatment options can be used. This test ensures we’re getting the best care to people quickly, while at the same time ensuring value for money for the taxpayer.”
A consultation on the draft recommendations is open until Wednesday, 8 June 2023 at via nice.org.uk
NICE has also issued final draft guidance, recommending dapagliflozin for adults with symptomatic chronic heart failure with preserved or mildly reduced ejection fraction – the first NICE recommended treatment for this specific condition.
Evidence from a clinical trial shows that adding dapagliflozin to standard care with diuretics reduces the combined risk of dying from cardiovascular causes or the likelihood of being hospitalised with heart failure for the first time, when compared with placebo plus standard care.
Helen Knight, director of medicines evaluation at NICE, said: “Until now there have been no treatments available to delay or slow the progression of this type of heart failure. The committee heard from patient and clinical experts who described how the lack of research and available treatments in this area led to a lack of hope and support that impacts the quality of life and mental health of people with the condition.”
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