First routine clopidogrel genotype testing introduced at health board

NHS Tayside in Scotland has secured funding to genotype all new patients with an acute indication for clopidogrel in cardiology, stroke and vascular surgery.

clopidogrel tablets blister pack — The service is the first healthcare system in the UK to offer pharmacogenomic testing for clopidogrel “as usual care”, according to NHS Tayside

A health board in Scotland is launching the first routine service for pharmacogenomic testing for clopidogrel in the UK.

In board papers for a Tayside NHS Board Performance and Resources Committee meeting, held in April 2022, NHS Tayside said it had established a pharmacotherapy hub and secured funding to genotype all new patients with an acute indication for the antiplatelet medicine in cardiology, stroke and vascular surgery.

NHS Tayside said the service made it the first healthcare system in the UK to offer pharmacogenomic testing for clopidogrel “as usual care”.

A joint report from the Royal College of Physicians and British Pharmacological Society, published in March 2022, called for wider implementation of pharmacogenomic testing in the NHS.

The report cited the potential of point-of-care genotyping tests for drugs such as clopidogrel.

The National Institute for Health and Care Excellence (NICE) is currently recruiting a committee to assess clopidogrel genotype testing following acute stroke.

In 2020, NICE looked at a point-of-care testing technology for CYP2C19 genotype testing in acute coronary syndromes and noted that guided antiplatelet therapy had not been shown to be better than standard care.

Commenting on the testing service, Helen Williams, a cardiovascular specialist pharmacist and national speciality adviser for cardiovascular disease prevention at NHS England, said: “Theoretically, it should be an advantage to know which of our patients have a poor response to clopidogrel therapy, but there are some outstanding questions in my mind.

“I would be interested to know whether it is simpler and cheaper to do the genomics testing or just to measure the effectiveness of clopidogrel through a platelet reactivity test.

“Also, whether by identifying poor responders to clopidogrel therapy and offering them an alternative antiplatelet actually results in better patient outcomes,” she said.

A spokesperson for the Scottish government said: “We are aware of the work being undertaken in NHS Tayside. There are no immediate plans to roll this out across Scotland.”