Investigate the Strategy of Using Pharmacogenetics and Pharmacometabonomics to the Personalization of Ticagrelor Antiplatelet Therapy

Background: Ticagrelor is an oral antiplatelet agent commonly used to inhibit P2Y12 receptors that bind to it inversely. It is classified as cyclopentyltriazolopyrimidine (CPTP). Unlike prasugrel and clopidogrel, ticagrelor does not require metabolism activation. Thus, in theory, it is less affected by the variability seen with CYP polymorphisms and thus produces a more stable antiplatelet effect. However, clinical and laboratory experiments showed some defects in the P2Y12 receptor antagonism of ticagrelor. Despite awareness of many genetic and non-genetic variables that pose challenges to personalising ticagrelor treatment, most of its variable platelet reactions remain unexplained. Pharmacometabonomics, a process of discovering new biomarkers of drug response or toxicity in biofluids, have been used to predict drug response. The strength of using the pharmacometabonomics technique is that it forecasts a response and offers extensive knowledge on the metabolic pathways of a response. Integrating pharmacogenetics with pharmacometabonomics provides insight into unknown response-related genetic and non-genetic factors. Method: The literature on the factors associated with the variable platelet reactivity of Ticagrelor was reviewed and the possible role of pharmacogenetics and pharmacometabonomics in the personalization of antiplatelet therapy with ticagrelor was discussed. Result: This review identified that pharmacometabonomic techniques are not presently used to predict the response to Ticagrelor. It also demonstrates that the use of pharmacogenetics alone to test the response to Ticagrelor has limitations. Conclusion: This study concluded that it is possible to use a combination of pharmacogenetics and pharmacometabonomics to predict the outcome of treatment with Ticagrelor.