Ticagrelor Reduced Cardiovascular Deaths and Heart Attacks in ACS Patients Undergoing Heart Procedures: New Data from PLATO Tria
25 September 2009 - 5:10AM
PR Newswire (US)
Significant effects shown with no increase in major bleeding
compared to clopidogrel in head-to-head trial SAN FRANCISCO, Sept.
24 /PRNewswire-FirstCall/ -- New data from the phase III PLATO
study showed that ticagrelor (BRILINTA(TM)) provided greater
reduction of cardiovascular (CV) events (composite of CV death,
heart attack and stroke) than clopidogrel (9.02% vs. 10.65%,
p=0.0025 a 16% Relative Risk Reduction ) in acute coronary
syndromes patients undergoing planned invasive treatment (either
PCI or CABG).* Although patients undergoing invasive procedures are
at greater risk of bleeding, these results were achieved without a
significant increase in major bleeding compared to clopidogrel
(11.5% vs 11.6%, p=0.88). Patients with planned invasive procedures
at randomization accounted for more than 70% of the greater than
18,000 patients in PLATO. These sub-analysis data were presented
today at the Transcatheter Cardiovascular Therapeutics (TCT)
conference in San Francisco. Additional findings from this PLATO
invasive sub-analysis showed that treatment with ticagrelor,
compared to clopidogrel, demonstrated an effect consistent with the
results for the entire invasive subgroup across the multiple
secondary efficacy endpoints. The effect was seen regardless of
whether a standard 300 mg loading dose of clopidogrel was given, or
an additional loading dose of clopidogrel (e.g. 600 mg) was given.
Specifically, results in this subgroup analysis indicated treatment
with ticagrelor: -- Reduced CV death 3.4% vs. 4.3% (p=0.025)
Relative Risk Reduction of 18% -- Reduced myocardial infarction
(heart attack, MI) 5.3% vs. 6.6% (p=0.002) Relative Risk Reduction
of 20% -- Reduced definite stent thrombosis 1.0% vs. 1.6% (p=0.003)
Relative Risk Reduction of 38% -- Reduced total mortality 3.9% vs.
5.1% (p=0.01) Relative Risk Reduction of 19% "The majority of
patients rushed to the hospital with severe chest pain or heart
attacks will have an invasive procedure," said Christopher Cannon,
M.D., PLATO Executive Committee member, a cardiologist at Brigham
and Women's Hospital in Boston. "Doctors need to make quick
decisions about antiplatelet therapy for patients who are sent for
cardiac catheterization and may need angioplasty or surgery. In
this study population, ticagrelor led to fewer heart attacks and
deaths without a significant increase in major bleeding versus
clopidogrel." Similar to the overall PLATO findings, Dyspnoea
(shortness of breath) was more common among patients on ticagrelor
but less than 1% discontinued ticagrelor treatment in the
sub-analysis because of dyspnoea. The PLATO study was designed to
reflect how patients with ACS are currently managed in clinical
practice, by including patients who underwent invasive procedures
and those who were managed with medication only. Last month, the
primary results from PLATO were presented at the European Society
of Cardiology and simultaneously published in The New England
Journal of Medicine in August 2009. AstraZeneca remains on track to
submit BRILINTA to regulatory authorities in the fourth quarter of
this year. About PLATO: PLATO (A Study of PLATelet Inhibition and
Patient Outcomes) was a head-to-head 18,624 patient outcomes study
of ticagrelor plus aspirin versus the active comparator,
clopidogrel plus aspirin, and was designed to establish whether
ticagrelor could achieve meaningful cardiovascular and safety
endpoints in ACS patients, above and beyond those afforded by
clopidogrel, an irreversible therapy in the thienopyridine class of
medicines. The study design of PLATO was published in the April
2009 edition of the American Heart Journal. The bleeding
definitions used within the PLATO trial were an evolution from the
CURE bleeding definitions and were developed by the PLATO Executive
Committee as constituting the most appropriate and clinically
meaningful assessment of bleeding complications associated with
acute and chronic therapy. The PLATO bleeding definitions provide a
framework to allow investigators to record all bleeding events
reported by patients in the PLATO trial. The bleeding definitions
were developed to characterize bleeding in both the acute and
long-term setting. Given the size of the PLATO database,
AstraZeneca will continue to analyze and publish additional PLATO
findings. NOTES TO EDITORS: About BRILINTA(TM) Ticagrelor
(BRILINTA(TM)) is an investigational oral antiplatelet treatment
for ACS. BRILINTA (ticagrelor) is a reversibly binding oral
adenosine diphosphate (ADP) receptor antagonist. It selectively
inhibits P2Y(12), a key target receptor for ADP. ADP receptor
blockade inhibits the action of platelets in the blood, reducing
recurrent thrombotic events. BRILINTA is the first in a new
chemical class, the CPTPs (cyclo-pentyl-triazolo-pyrimidines) and
is chemically distinct from the thienopyridines, such as
clopidogrel and prasugrel. AstraZeneca has proposed the name
BRILINTA(TM) in the US. If approved by the FDA it will serve as the
trade name for ticagrelor. BRILINTA is a trademark of the
AstraZeneca group of companies. *About Invasive Strategies for
Acute Coronary Syndromes Percutaneous coronary intervention (PCI)
is a procedure to open existing blocked arteries, also known as
angioplasty. Coronary artery bypass graft (CABG) is a procedure
where surgeons bypass the affected artery in the heart. About
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business engaged in the research, development, manufacturing and
marketing of meaningful prescription medicines and supplier for
healthcare services. AstraZeneca is one of the world's leading
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respiratory, oncology and infectious disease medicines. In the
United States, AstraZeneca is a $13.35 billion dollar healthcare
business with 12,200 employees committed to improving people's
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