my personal edition > angina pectoris/mi > news


  E-Mail this DGDispatch to a colleague

DGDispatch

Ticagrelor Reduces Events Among STEMI Patients Compared With Clopidogrel: Presented at AHA

By Ric Susman

ORLANDO, Fla -- November 16, 2009 -- Ticagrelor, an investigational platelet-aggregation inhibitor, appears to reduce coronary events among patients diagnosed with ST-segment elevated myocardial infarction (STEMI) who are headed for percutaneous coronary interventions when compared with clopidogrel (standard treatment), researchers said here at the American Heart Association (AHA) Scientific Sessions 2009.

In a substudy analysis of the Study of Platelet Inhibition and Patient Outcomes (PLATO), about 8.3% of patients with STEMI who were treated with ticagrelor experienced the primary endpoint -- a composite of cardiovascular death, myocardial infarction, or stroke -- compared with 11.3% of patients assigned to treatment with clopidogrel, stated Gabriel Steg, MD, University of Paris/Hôpital Bichat, Paris, France, speaking here at a presentation on November 15. The comparison demonstrates a relative risk reduction of 15% (P = .02), Dr. Steg added.

Dr. Steg and colleagues analysed 4,201 patients treated with ticagrelor and 4,229 patients treated with clopidogrel -- or about 45% of the 18,000 people enrolled in the overall study reported at the European Society of Cardiology meeting in August 2009.

"These results indicate that ticagrelor may become a new standard of care for the management of patients with STEMI intended for primary percutaneous coronary interventions," Dr. Steg commented.

He said that treatment with ticagrelor resulted in a relative risk reduction in definite stent thrombosis of 39% -- 1.6% of ticagrelor patients experienced stent thrombosis compared with 2.5% of clopidogrel patients (P = .01) -- and a relative risk reduction in overall mortality of 18% (P = .04). Dr. Steg's analysis observed no increase in major bleeding events.

As the designated discussant of the trial, Lisa Jennings, PhD, Vascular Biology Center of Excellence, University of Tennessee Health Science Center, Memphis, Tennessee, commented, "A more rapid reversible characteristic may make this agent well suited for inhibiting platelet function under appropriate clinical conditions, while reducing the risk of bleeding complication."

"The reversible receptor binding and a 12-hour half-life necessitate twice-daily dosing, however, which might be a challenge in patients who are not fully compliant," she added.

In a prepared statement, Christina Trank, Bristol-Myers Squibb, New York, New York, suggested that more data may be needed before the drug replaces clopidogrel as a treatment of choice.

"Ticagrelor is an investigational drug and has not been approved by any regulatory authorities," Trank noted. "Ticagrelor's efficacy and safety have been demonstrated in a clinical-trial setting in the acute coronary syndrome population, and in the real world setting, the efficacy and safety is still unknown. We look forward to learning more about the study results in order to have a more complete understanding of this drug's profile."

[Presentation title: Comparison of Ticagrelor, the First Reversible Oral P2Y12 Receptor Antagonist, With Clopidogrel in Patients With ST-Elevation Acute Coronary Syndromes: Results From the Platelet Inhibition and Patient Outcomes (PLATO) Trial. Abstract 09-LBCT-20015]

E-Mail this DGDispatch to a colleague

To print, use this version