Please use this identifier to cite or link to this item:
|Title:||Genotype-guided versus traditional clinical dosing of warfarin in patients of Asian ancestry: A randomized controlled trial||Authors:||Syn N.L.
|Issue Date:||10-Jul-2018||Publisher:||BioMed Central Ltd.||Citation:||Syn N.L., Wong A.L.-A., Lee S.-C., Teoh H.-L., Yip J.W.L., Seet R.C.S., Yeo W.T., Kristanto W., Bee P.-C., Poon L.M., Marban P., Wu T.S., Winther M.D., Brunham L.R., Soong R., Tai B.-C., Goh B.-C. (2018-07-10). Genotype-guided versus traditional clinical dosing of warfarin in patients of Asian ancestry: A randomized controlled trial. BMC Medicine 16 (1) : 104. ScholarBank@NUS Repository. https://doi.org/10.1186/s12916-018-1093-8||Abstract:||Background: Genotype-guided warfarin dosing has been shown in some randomized trials to improve anticoagulation outcomes in individuals of European ancestry, yet its utility in Asian patients remains unresolved. Methods: An open-label, non-inferiority, 1:1 randomized trial was conducted at three academic hospitals in South East Asia, involving 322 ethnically diverse patients newly indicated for warfarin (NCT00700895). Clinical follow-up was 90days. The primary efficacy measure was the number of dose titrations within the first 2weeks of therapy, with a mean non-inferiority margin of 0.5 over the first 14days of therapy. Results: Among 322 randomized patients, 269 were evaluable for the primary endpoint. Compared with traditional dosing, the genotype-guided group required fewer dose titrations during the first 2weeks (1.77 vs. 2.93, difference -1.16, 90% CI -1.48 to -0.84, P<0.001 for both non-inferiority and superiority). The percentage of time within the therapeutic range over 3months and median time to stable international normalized ratio (INR) did not differ between the genotype-guided and traditional dosing groups. The frequency of dose titrations (incidence rate ratio 0.76, 95% CI 0.67 to 0.86, P=0.001), but not frequency of INR measurements, was lower at 1, 2, and 3months in the genotype-guided group. The proportions of patients who experienced minor or major bleeding, recurrent venous thromboembolism, or out-of-range INR did not differ between both arms. For predicting maintenance doses, the pharmacogenetic algorithm achieved an R 2 =42.4% (P<0.001) and mean percentage error of -7.4%. Conclusions: Among Asian adults commencing warfarin therapy, a pharmacogenetic algorithm meets criteria for both non-inferiority and superiority in reducing dose titrations compared with a traditional dosing approach, and performs well in prediction of actual maintenance doses. These findings imply that clinicians may consider applying a pharmacogenetic algorithm to personalize initial warfarin dosages in Asian patients. © 2018 The Author(s).||Source Title:||BMC Medicine||URI:||http://scholarbank.nus.edu.sg/handle/10635/151674||ISSN:||1741-7015||DOI:||10.1186/s12916-018-1093-8|
|Appears in Collections:||Elements|
Show full item record
Files in This Item:
|s12916-018-1093-8.pdf||1.29 MB||Adobe PDF|
checked on Dec 5, 2021
WEB OF SCIENCETM
checked on Sep 21, 2021
checked on Dec 2, 2021
checked on Dec 2, 2021
Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.