New Data Suggests BRILINTA (ticagrelor) Reduced First and Recurrent Cardiovascular and Ischemic Events
PLATO sub-analysis on the effects of BRILINTA versus clopidogrel for second events, including urgent revascularization, recurrent ischemia, transient ischemic attacks and arterial thromboses in patients with ACS
CHICAGO--(BUSINESS WIRE)--Mar 25, 2012 - AstraZeneca (NYSE: AZN) today announced new data from a sub-analysis of the PLATO study that suggests that BRILINTA® (ticagrelor) tablets resulted in a reduction in hazard for time to first events, recurrent cardiovascular (CV) and ischemic events, when compared to clopidogrel. These data were presented today by Dr. Payal Kohli of the TIMI Study Group and Brigham and Women's Hospital, at the American College of Cardiology Scientific Sessions (ACC), in Chicago, Ill.
“The understanding of the impact of antiplatelet therapy on recurrent and total events is important for clinicians,” said Dr. Christopher Cannon, Professor of Medicine, Harvard Medical School. “We usually just count the first event in the trials, but looking at the total number of events reduced – we see more events reduced with ticagrelor vs. clopidogrel. These new data suggest that treatment with ticagrelor for up to one year reduced hazard for time to first and recurrent events, including cardiovascular death.”
Specific data from this sub-analysis showed:
- Ticagrelor as compared with clopidogrel reduced total events, i.e., first and second events: cardiovascular CV death, myocardial infarction (MI), stroke, severe recurrent ischemia (SRI), recurrent ischemia (RI), transient ischemic attack (TIA), arterial thrombotic events (ATE) were for ticagrelor n=2,030 (1,290 first events, 740 recurrent events) versus clopidogrel n=2,290 (1,456 first events, 834 recurrent events); (rate ratio 0.88; [95% CI; 0.80-0.98]; P=0.01). The rate ratio for total number of primary endpoints was reduced with ticagrelor compared to clopidogrel; CV death, MI, stroke (RR 0.86; [0.79-0.93]; P<0.001)
- Ticagrelor also reduced hazard for time to second event/death for CV death, MI, stroke (HR 0.80; [0.70-0.90]; P<0.001); CV death, MI, stroke, SRI, RI, TIA, ATE (HR 0.83; [0.75-0.91]; P<0.001); CV death, MI, stroke, urgent revascularization (HR 0.80; [0.71-0.91]; P<0.001)
- With respect to safety endpoints, there was an increase with ticagrelor in total number of TIMI major non-CABG bleeds, as compared to clopidogrel (234 vs. 188); P=0.03; Although first occurrences of bleeding increased with ticagrelor (221 vs. 177); P=0.03; recurrent bleeding events were rare in both groups (13 vs. 11); P=0.69
In PLATO, 18,624 patients with ACS were randomized to ticagrelor versus clopidogrel with median follow-up of 277 days. Among patients taking ticagrelor, there was a mean number of 1,057 total primary endpoint events versus 1,225 in patients on clopidogrel (rate ratio=0.86 [0.79-0.93]; P<0.001). There was an observed reduction in mean number of events per patient, and a reduction in second occurrences of CV death, MI or stroke with ticagrelor and a reduction for first, second and total ischemic events.
BRILINTA is indicated to reduce the rate of thrombotic cardiovascular events in patients with ACS (unstable angina [UA], non–ST-elevation myocardial infarction [NSTEMI], or ST-elevation myocardial infarction [STEMI]). BRILINTA has been shown to reduce the rate of a combined end point of CV death, MI, or stroke compared to clopidogrel. The difference between treatments was driven by CV death and MI with no difference in stroke. In patients treated with an artery-opening procedure known as percutaneous coronary intervention (PCI), BRILINTA reduces the rate of stent thrombosis.
BRILINTA has been studied in ACS in combination with aspirin. Maintenance doses of aspirin above 100 mg decreased the effectiveness of BRILINTA. Avoid maintenance doses of aspirin above 100 mg daily.
IMPORTANT SAFETY INFORMATION ABOUT BRILINTA
WARNING: BLEEDING RISK
- BRILINTA, like other antiplatelet agents, can cause significant, sometimes fatal, bleeding
- Do not use BRILINTA in patients with active pathological bleeding or a history of intracranial hemorrhage
- Do not start BRILINTA in patients planned to undergo urgent coronary artery bypass graft surgery (CABG). When possible, discontinue BRILINTA at least 5 days prior to any surgery
- Suspect bleeding in any patient who is hypotensive and has recently undergone coronary angiography, percutaneous coronary intervention (PCI), CABG, or other surgical procedures in the setting of BRILINTA
- If possible, manage bleeding without discontinuing BRILINTA. Stopping BRILINTA increases the risk of subsequent cardiovascular events
WARNING: ASPIRIN DOSE AND BRILINTA EFFECTIVENESS
- Maintenance doses of aspirin above 100 mg reduce the effectiveness of BRILINTA and should be avoided. After any initial dose, use with aspirin 75 mg - 100 mg per day
- BRILINTA is contraindicated in patients with a history of intracranial hemorrhage and active pathological bleeding such as peptic ulcer or intracranial hemorrhage. BRILINTA is also contraindicated in patients with severe hepatic impairment because of a probable increase in exposure; it has not been studied in these patients. Severe hepatic impairment increases the risk of bleeding because of reduced synthesis of coagulation proteins
WARNINGS AND PRECAUTIONS
- Moderate Hepatic Impairment: Consider the risks and benefits of treatment, noting the probable increase in exposure to ticagrelor
- Premature discontinuation increases the risk of MI, stent thrombosis, and death
- Dyspnea was reported in 14% of patients treated with BRILINTA and in 8% of patients taking clopidogrel. Dyspnea resulting from BRILINTA is self-limiting. Rule out other causes
- BRILINTA is metabolized by CYP3A4/5. Avoid use with strong CYP3A inhibitors and potent CYP3A inducers. Avoid simvastatin and lovastatin doses >40 mg
- Monitor digoxin levels with initiation of, or any change in, BRILINTA therapy
- The most commonly observed adverse reactions associated with the use of BRILINTA vs clopidogrel were Total Major Bleeding (11.6% vs 11.2%) and dyspnea (14% vs 8%)
- In clinical studies, BRILINTA has been shown to increase the occurrence of Holter-detected bradyarrhythmias. PLATO excluded patients at increased risk of bradycardic events. Consider the risks and benefits of treatment
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
The PLATO trial was a large (18,624 patients in 43 countries) head-to-head outcomes study of ticagrelor versus clopidogrel, both given in combination with aspirin and other standard therapy, designed to establish whether ticagrelor could achieve a clinically meaningful reduction in cardiovascular end points in ACS patients, above and beyond those afforded by clopidogrel.
The PLATO study demonstrated that treatment with BRILINTA led to a greater reduction in the primary end point – a composite of CV death, MI, or stroke – compared to patients who received clopidogrel (9.8% vs 11.7% at 12 months; 1.9% absolute risk reduction [ARR]; 16% relative risk reduction [RRR]; 95% CI, 0.77 to 0.92; P<0.001). The difference in treatments was driven by CV death and MI with no difference in stroke. In PLATO, the absolute difference in treatment benefit versus clopidogrel was seen at 30 days and the Kaplan-Meier survival curves continue to diverge throughout the 12-month treatment period.
It's important to know that BRILINTA does have a Boxed Warning for bleeding risks. BRILINTA, like other antiplatelet agents, can cause significant, sometimes fatal, bleeding. In addition, BRILINTA has a Boxed Warning concerning aspirin dose and BRILINTA effectiveness. Maintenance doses of aspirin above 100 mg reduce the effectiveness of BRILINTA and should be avoided. After any initial dose, use with aspirin 75 mg - 100 mg per day.
The PLATO study also demonstrated that treatment with BRILINTA for 12 months was associated with a 21 percent RRR in CV death (4% vs 5.1%; 1.1% ARR; P=0.001) and a 16 percent RRR in MI compared to clopidogrel at 12 months (5.8% vs 6.9%; 1.1% ARR; P<0.005).
The primary safety end point in the PLATO study was Total Major Bleeding (11.6% for BRILINTA and 11.2% for clopidogrel). In PLATO, non-CABG (coronary artery bypass graft) major + minor bleeding events (8.7% vs. 7%) were more common with BRILINTA versus clopidogrel. The rate of non–CABG-related major bleeding was higher for BRILINTA (4.5%) vs clopidogrel (3.8%).
In a post hoc analysis of PLATO, it was determined that more than 80 percent of patients worldwide, with approximately 40 percent of patients in the US, received low maintenance doses of aspirin (100 mg or less). Results for US and non-US patients taking BRILINTA with these low maintenance doses of aspirin were similar. As with any unplanned subset analysis, the post hoc analysis should be treated with caution. Despite the need to treat such results cautiously, there appears to be good reason to restrict aspirin maintenance dosage accompanying ticagrelor to 100 mg. The PI states that maintenance doses of aspirin above 100 mg reduce the effectiveness of BRILINTA, and should be avoided. After any initial dose, BRILINTA should be used with maintenance aspirin doses of 75 mg - 100 mg per day.
About BRILINTA (ticagrelor) tablets
BRILINTA is an oral antiplatelet treatment for acute coronary syndrome (ACS) in a new chemical class called cyclopentyltriazolopyrimidines (CPTPs). BRILINTA works by inhibiting platelet activation and has been shown to reduce the rate of thrombotic cardiovascular events, such as a heart attack or cardiovascular death, in patients with ACS. BRILINTA is a reversibly binding oral platelet P2Y12 adenosine diphosphate (ADP) receptor antagonist.
BRILINTA is available in 90-mg tablets to be administered with a single 180-mg oral loading dose (two 90-mg tablets) followed by a twice daily, 90-mg maintenance dose. Following an initial loading dose of aspirin, BRILINTA should be used with a maintenance dose of 75 mg - 100 mg aspirin once daily, 81-mg aspirin dose in the US.
BRILINTA is a trademark of the AstraZeneca group of companies.
About Acute Coronary Syndrome (ACS)
ACS is an umbrella term for conditions that result from insufficient blood supply to the heart muscle. These conditions range from unstable angina (UA), non–ST-elevation myocardial infarction (NSTEMI), or ST-elevation myocardial infarction (STEMI).
NOTES TO EDITORS:
AstraZeneca is a global, innovation-driven biopharmaceutical business with a primary focus on the discovery, development and commercialization of prescription medicines for gastrointestinal, cardiovascular, neuroscience, respiratory and inflammation, oncology and infectious disease. AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide.
For more information about AstraZeneca in the US or our AZ&Me™ Prescription Savings programs, please visit: www.astrazeneca-us.com or call 1-800-AZandMe (292-6363).
Media Inquiries US
Stephanie Jacobson +1 302 885 5924
mob. +1 302 379 0443
Julia Walker +1 302 885 5172
mob. +1 610 350 8240
Ed Seage +1 302 886 4065
mob: +1 302 373 1361
Jorgen Winroth +1 212 579 0506
mob: +1 917 612 4043
Posted: March 2012