One-Year Clinical Effectiveness Comparison of Prasugrel with Ticagrelor: Results from a Retrospective Observational Study using an Integrated Claims Database
- 166 Downloads
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.
- 1.Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:e344–426.CrossRefPubMedGoogle Scholar
- 2.O’Gara PT, Kushner FG, Ascheim DD, et al. ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;2013(127):e362–425.Google Scholar
- 3.Windecker S, Kolh P, Alfonso F, et al. ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35:2541–619.CrossRefPubMedGoogle Scholar
- 4.Levine GN, Bates ER, Bittl JA, et al. ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2016;68(10):1082–115. https://doi.org/10.1016/j.jacc.2016.03.513.CrossRefPubMedGoogle Scholar
- 5.Bagai A, Peterson ED, Honeycutt E, et al. In-hospital switching between adenosine diphosphate receptor inhibitors in patients with acute myocardial infarction treated with percutaneous coronary intervention: Insights into contemporary practice from the TRANSLATE-ACS study. Eur Heart J Acute Cardiovasc Care. 2015;4:499–508.CrossRefPubMedGoogle Scholar
- 12.Simeone JC, Molife C, Marrett E, et al. One-year post-discharge resource utilization and treatment patterns of patients with acute coronary syndrome managed with percutaneous coronary intervention and treated with ticagrelor or prasugrel. Am J Cardiovasc Drugs. 2015;15:337–50.CrossRefPubMedGoogle Scholar
- 13.AstraZeneca. Brilinta [package insert] 2017 https://www.azpicentral.com/brilinta/brilinta.pdf#page=1. Accessed July 05 2017.
- 14.Eli Lilly and Company. Effient [package insert]. 2017. http://pi.lilly.com/us/effient.pdf. Accessed July 05 2017.
- 24.Wang TY, Zettler M, Effron MB, et al. Comparative effectiveness of prasugrel vs. clopidogrel among acute myocardial infarction patients treated with percutaneous coronary intervention: 30-day outcomes from the TRANSLATE-ACS observational study. J Am Coll Cardiol. 2013;62(18_S1):B1. https://doi.org/10.1016/j.jacc.2013.08.729.CrossRefGoogle Scholar
- 25.Baber U, Sartori S, Aquino M, et al. 90-Day Effectiveness and Safety of Prasugrel vs. Clopidogrel as Used in Clinical Practice in Patients With ACS Undergoing PCI: Initial Findings from the PROMETHEUS Study. Society for Cardiovascular Angiography and Interventions—38th Annual Scientific Sessions. 2015.Google Scholar
- 26.Larmore C, Effron MB, Molife C, et al. ”Real-World” comparison of prasugrel with ticagrelor in patients with acute coronary syndrome treated with percutaneous coronary intervention in the United States. Catheter Cardiovasc Interv. 2016;88(4):535–44. https://doi.org/10.1002/ccd.26279.CrossRefPubMedGoogle Scholar
- 31.Jeong HS, Hong SJ, Cho SA, et al. Comparison of ticagrelor versus prasugrel for inflammation, vascular function, and circulating endothelial progenitor cells in diabetic patients with non–ST-segment elevation acute coronary syndrome requiring coronary stenting: a prospective, randomized, crossover trial. JACC Cardiovasc Interv. 2017;10:1646–58.CrossRefPubMedGoogle Scholar
- 39.Kohli P, Udell JA, Murphy SA, et al. Discharge aspirin dose and clinical outcomes in patients with acute coronary syndromes treated with prasugrel versus clopidogrel: an analysis from the TRITON-TIMI 38 study (trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction 38). J Am Coll Cardiol. 2014;63:225–32.CrossRefPubMedGoogle Scholar