Positive data from trial of Brilinta (ticagrelor) in ACS patients-AstraZeneca

Brilinta (ticagrelor), from AstraZeneca, works faster and is more effective in blocking platelet activity in low-­risk patients with acute coronary syndrome (ACS) than clopidogrel, according to a new study. In the trial, 100 patients were randomized to receive either ticagrelor (180 mg loading dose and 90 mg after 12 hours) or clopidogrel (600 mg loading dose) with aspirin (75-­100 mg daily) at the time of PCI. The primary endpoint of the study was platelet reactivity at two hours.

The study found platelet activity differed as early as one-­half hour after the medication was administered. Significant reduction in platelet activity began as early as the end of PCI, which occurred a mean 0.6 hours after the medication was given, and continued to decrease at eight hours. The study suggests low-­risk patients undergoing ad hoc PCI may fare better with ticagrelor. Data were presented at the Society for Cardiovascular Angiography and Interventions 2015 Scientific Sessions.

Comment: Merck's competitor, PAR-1 receptor antagonist Zontivity (vorapaxar), won approval last year for patients with a prior heart attack, based on study TRA 2P, which randomized patients with a heart attack between two and 12 months. The hazard ratio on the primary endpoint versus placebo was 0.83, with GUSTO severe bleeding increased by 24%. Zontivity is given in combination with both aspirin and clopidogrel, as opposed to just DAPT (dual antiplatelet therapy with aspirin plus clopidogrel, Brilinta, or Effient), so there are possible concerns about its bleeding risk.