We performed the first meta-analysis of Russian prospective studies and compared a dose-selection strategy that used pharmacogenetic information to one that did not. We searched PubMed and eLibrary through September 3...We performed the first meta-analysis of Russian prospective studies and compared a dose-selection strategy that used pharmacogenetic information to one that did not. We searched PubMed and eLibrary through September 30, 2013. We included seven Russians prospective studies that compared pharmacogenetic-guided warfarin dosing group, using polymorphisms of CYP2C9, VKORC1 and CYP4F2, to a dosing algorithm that did not incorporate genetic testing. Clinical outcomes were both the major and minor bleedings and the cases of elevated INR. Quantitative data synthesis was performed using MIX Pro 2.0. 6 studies compared the cases of bleedings between two groups. There was no evidence of statistical heterogeneity, so patient＇s characteristics could not impact on results. Genetic-based warfarin dosing decreases the risk of bleeding. Pooled odds ratio was significant for＂major＂ （OR = 0.07, 95% CI 0.008-0.54; P = 0.01） and both ＂minor＂ and ＂major＂ bleedings （OR = 0.49; 95% CI 0.31-0.78; P = 0.002）. Six studies evaluated the cases of elevated INR. There was no evidence of statistical heterogeneity （Q-test P = 0.13, 12 = 40%）. Four studies were powered to show a difference in elevated INR （P 〈 0.05）. Pooled odds ratio was significant （OR = 0.21, 95% CI 0.15-0.3; P 〈 0.01）. The intervention groups contained the fewer cases of elevated INR compared to the control groups. Genotype-based warfarin dosing reduces the risk ofbleedings （especially major bleedings） and cases of elevated INR. Results of meta-analysis depend on the quality of included studies and should be interpreted with caution.展开更多
文摘We performed the first meta-analysis of Russian prospective studies and compared a dose-selection strategy that used pharmacogenetic information to one that did not. We searched PubMed and eLibrary through September 30, 2013. We included seven Russians prospective studies that compared pharmacogenetic-guided warfarin dosing group, using polymorphisms of CYP2C9, VKORC1 and CYP4F2, to a dosing algorithm that did not incorporate genetic testing. Clinical outcomes were both the major and minor bleedings and the cases of elevated INR. Quantitative data synthesis was performed using MIX Pro 2.0. 6 studies compared the cases of bleedings between two groups. There was no evidence of statistical heterogeneity, so patient＇s characteristics could not impact on results. Genetic-based warfarin dosing decreases the risk of bleeding. Pooled odds ratio was significant for＂major＂ （OR = 0.07, 95% CI 0.008-0.54; P = 0.01） and both ＂minor＂ and ＂major＂ bleedings （OR = 0.49; 95% CI 0.31-0.78; P = 0.002）. Six studies evaluated the cases of elevated INR. There was no evidence of statistical heterogeneity （Q-test P = 0.13, 12 = 40%）. Four studies were powered to show a difference in elevated INR （P 〈 0.05）. Pooled odds ratio was significant （OR = 0.21, 95% CI 0.15-0.3; P 〈 0.01）. The intervention groups contained the fewer cases of elevated INR compared to the control groups. Genotype-based warfarin dosing reduces the risk ofbleedings （especially major bleedings） and cases of elevated INR. Results of meta-analysis depend on the quality of included studies and should be interpreted with caution.
