Stroke patients could be offered genetic test to identify most suitable treatment

Patients who have recently had a stroke or Transient Ischaemic Attack (TIA) could be offered a genetic test to identify the most effective treatment course.

New draft guidance from NICE states that clinicians considering treating stoke patients with clopidogrel – currently recommended as a treatment option for those at risk of secondary stroke – should offer CYP2C19 genotype testing.

This is because stroke patients with one of the CYP2C19 gene variants are at increased risk of another stroke when taking clopidogrel. The genetic test would identify those who would benefit from alternative medications, enabling them to receive more effective treatment.

Genetic testing only recommended for those who have recently had a stroke or TIA

Around 35,850 people in England, Wales and Northern Ireland have a non-minor stroke each year, and roughly a third (32%) are estimated to have at least one of the CYP2C19 gene variants. The variants are more common in people with an Asian family background but can be found in people of any ethnicity.

The draft guidance recommends testing only for people who have very recently had a stroke or TIA. This is because the risk of another event is higher in the immediate period after a stroke, with the risk of reoccurrence reducing over time.

For this reason, NICE recommends that clinicians do not offer the test to those already taking clopidogrel. Patients currently taking clopidogrel should continue with the treatment until they and their NHS clinician consider it appropriate to stop.

Laboratory-based CYP2C19 genotype testing is the committee’s preferred option followed by Genedrive CYP2C19 ID Kit point-of-care test. If neither of the first two options are available, the Genomadix Cube point-of-care test can be used.

If the test discovers they have one of the CYP2C19 gene variants, the person can be treated with another medicine to prevent future strokes.

Guidance would ensure stroke patients receive personalised treatment

Professor Jonathan Benger, chief medical officer at NICE, said the guidance, if passed, would help to ensure people receive the best possible personalised treatment.

“We recognise that capacity within laboratories will need to increase before everyone who has had a new stroke or ‘mini-stroke’ can receive testing.

“While point of care testing is an alternative, our committee has identified that initially those people who could benefit most from laboratory-based testing are those who have had a non-minor stroke,” he said.

The Stroke Association has also welcomed the draft guidance, and Juliet Bouverie from the charity said it could improve patient outcomes.

She said: “Stroke devastates lives and leaves people with life-long disability. We know that many stroke survivors spend the rest of their lives fearing another stroke, so it’s great to see that more people could be given appropriate help to significantly cut their risk of recurrent stroke.

“Getting on the right medication and taking it as advised can really go far to prevent further strokes. If you have been prescribed clopidogrel, you need to keep taking it. If you’re worried about your risk of another stroke, you should speak to your doctor.”