One-Year Clinical Effectiveness Comparison of Prasugrel with Ticagrelor: Results from a Retrospective Observational Study using an Integrated Claims Database
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No direct comparisons of ticagrelor and prasugrel with 1-year clinical follow-up have been reported.
Our objective was to compare 1-year clinical outcomes among patients with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI) and treated with either ticagrelor or prasugrel in a real-world setting.
This retrospective study included patients from a payer database who were aged ≥18 years and had ACS managed with PCI with no history of transient ischemic attack (TIA)/stroke. Data were propensity matched for prasugrel use with a 3:1 prasugrel:ticagrelor ratio. Post-discharge net adverse clinical event (NACE) rate at 1 year was evaluated for noninferiority using a pre-defined 20% margin. NACE was a composite of major adverse cardiovascular events (MACE) or rehospitalization for bleeding.
In total, 15,788 ACS-PCI patients were included (prasugrel 12,797; ticagrelor 2991). Prasugrel-treated patients were younger; less likely to be female, have prior myocardial infarction (MI), diabetes, or non-ST-segment elevation MI (NSTEMI); and more likely to have unstable angina (UA) than ticagrelor-treated patients. Prior to matching, NACE and MACE (P < 0.01) were lower, with no difference in bleeding with prasugrel compared with ticagrelor. After matching, there was no significant difference in baseline characteristics. Noninferiority was demonstrated for NACE, MACE, and bleeding between prasugrel and ticagrelor. NACE and MACE were significantly lower with prasugrel use, primarily driven by heart failure, with no significant difference in all-cause death, MI, UA, revascularization, TIA/stroke, or bleeding.
In this retrospective study, physicians preferentially used prasugrel rather than ticagrelor in younger ACS-PCI patients with lower risk of bleeding or comorbidities. After propensity matching, clinical outcomes associated with prasugrel were noninferior to those with ticagrelor.
The authors thank Doug Faries, PhD, Hsiao Lieu, MD, Molly Tomlin, MS, Nayan Acharya, MD (deceased), and Vladimir Kryzhanovski, MD, at Eli Lilly and Company; Feride Frech-Tamas, PhD, Elizabeth Marrett, MPH, and Qiaoyi Zhang, PhD, at Daiichi Sankyo Inc.; and Teresa Bennett and Jaime Lucove at Symphony Health Solutions, for valuable contributions to this study and manuscript.
Compliance with ethical standards
This study was funded by Daiichi Sankyo Inc., Parsippany, NJ, USA, and Eli Lilly and Company, Indianapolis, IN, USA.
Conflict of interest
MBE is a shareholder of, receives a pension from, and—at the time of the study—was an employee of Eli Lilly and Company. CM, SK, YZ, and PLM are shareholders and employees of Eli Lilly and Company. GV is an unpaid consultant to Daiichi Sankyo and Eli Lilly. KVN and RLP II are paid consultants to Daiichi Sankyo and Eli Lilly. JCS, BLN, and BM are employed by Evidera, which received funding from Eli Lilly and Company and Daiichi Sankyo Inc. to conduct this research.
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