Genotype-Guided Dosing of Warfarin in Chinese Adults
| Autor: | Yong Huo, Shanjie Jiang, Honghao Zhou, Gaofeng Zeng, Qiulian Fang, Yuming Zhang, Shan Tu, Jie Huang, Yun Kuang, Hongyi Tan, Yimin Cui, Fanghua Xu, Xiaoliang Chen, Chan Zou, Chee M. Ng, Jingjing Cai, Zhiyuan Yang, Xue Sun, Jianqiang Peng, Jianping Zeng, Wanying Yu, Guozuo Xiong, Weihong Jiang, Jingjing Yu, Haigang Li, Qi Pei, Xiangjiang Shi, Xianming Wu, Zhijun Huang, Guoping Yang, Liying Gong, Zaixin Yu, Yuxia Xiang, Jinfu Peng, Hao Gong, Hong Yuan, Lu Huang, Liu Yang, Xiaoyan Wang, Da Miao, Xiaobin Wang, Chunmei Lv, Xiaoping Chen, Zijing Peng, Qiong Yang, Jie Wu, Xiaomin Wang, Peng Chen, Wenyu Liu, Jingle Li, Xiaohong Tang, Chengxian Guo, Haiying Dai, Zewei Ouyang |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry Warfarin Chinese adults Atrial fibrillation General Medicine 030204 cardiovascular system & hematology medicine.disease law.invention 03 medical and health sciences 0302 clinical medicine Therapeutic index Randomized controlled trial law Internal medicine Genotype medicine 030212 general & internal medicine Dosing business Pharmacogenetics medicine.drug |
| Zdroj: | Circulation: Genomic and Precision Medicine. 13 |
| ISSN: | 2574-8300 |
| Popis: | Background: Warfarin is an effective treatment for thromboembolic disease but has a narrow therapeutic index; optimal anticoagulation dosage can differ tremendously among individuals. We aimed to evaluate whether genotype-guided warfarin dosing is superior to routine clinical dosing for the outcomes of interest in Chinese patients. Methods: We conducted a multicenter, randomized, single-blind, parallel-controlled trial from September 2014 to April 2017 in 15 hospitals in China. Eligible patients were ≥18 years of age, with atrial fibrillation or deep vein thrombosis without previous treatment of warfarin or a bleeding disorder. Nine follow-up visits were performed during the 12-week study period. The primary outcome measure was the percentage of time in the therapeutic range of the international normalized ratio during the first 12 weeks after starting warfarin therapy. Results: A total of 660 participants were enrolled and randomly assigned to a genotype-guided dosing group or a control group under standard dosing. The genotype-guided dosing group had a significantly higher percentage of time in the therapeutic range than the control group (58.8% versus 53.2% [95% CI of group difference, 1.1–10.2]; P =0.01). The genotype-guided dosing group also achieved the target international normalized ratio sooner than the control group. In subgroup analyses, warfarin normal sensitivity group had an even higher percentage of time in the therapeutic range during the first 12 weeks compared with the control group (60.8% versus 48.9% [95% CI, 1.1–24.4]). The incidence of adverse events was low in both groups. Conclusions: The outcomes of genotype-guided warfarin dosing were superior to those of clinical standard dosing. These findings raise the prospect of precision warfarin treatment in China. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02211326. |
| Databáze: | OpenAIRE |
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