Pharmacogenomic Variability in Bangladeshi Patients – A Case Study on CYP2C19 Polymorphism and Clopidogrel Resistance

The CYP2C19 gene is one of the polymorphisms that affects the effectiveness of Clopidogrel, this critical antiplatelet medication used in managing cardiovascular diseases (CVD). Such genetic variations can make patients resistant to clopidogrel, that is, they do not effectively respond to the medication and thus increase the risk of cardiovascular adverse events. In this case report, we emphasise the need for pharmacogenomic testing in personalizing treatment strategies for patients in Bangladesh, where such testing is not routinely done. The CYP2C19 gene is highly polymorphic and variants such as CYP2C19*2 and CYP2C19*3 responsible for reduced enzyme activity impairing conversion of clopidogrel to a pharmacologically active form are associated with reduced activity. These loss of function alleles have been shown to be associated with clopidogrel resistance and therefore less optimal therapeutic outcomes, as have been reported in studies Su et al. Due to lack of routine genetic testing, Bangladeshi patients face two potentially catastrophic problems regarding BMPT; some are poor metabolizers and yet remain undiagnosed, while other patients remain undiagnosed despite their biology making clopidogrel without benefit, which leads to treatment failure and increasing risk for cardiovascular events. The findings from this case report advocate for the integration of pharmacogenomic testing into clinical practice in Bangladesh. Defining patients with a genetic propensity to clopidogrel resistance enables healthcare providers to select other antiplatelet therapy for some, including ticagrelor or prasugrel that do not require CYP2C19 for activation. Such a personalized approach would greatly improve patient outcomes and reduce major adverse cardiovascular events in the Bangladeshi population.