AstraZeneca’s Brilinta said to be effective in long-Term DAPT

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A new clinical study funded by AstraZeneca has found that the long-term use of the company’s newer anti-clotting drug dubbed Brilinta not only reduces heart attack survivors’ future risk of heart attack, it also brings down the risk factor of stroke or heart-related death.

The study was led by Dr. Marc Sabatine, a cardiologist at Brigham and Women’s Hospital and Harvard Medical School in Boston. The study tracked outcomes for 21,162 myocardial infarction patients across 31 countries with all of them having survived a heart attack in the previous one to three years. Another point about the recruits was that they were either suffering from diabetes or older age thereby putting them at a greater risk for another heart attack and were taking aspirin as a preventive measure.

For the study, patients were randomly given a twice-daily dose of either 90 milligrams (mg) of Brilinta (ticagrelor), 60 mg of the drug, or an inactive placebo. All of them continued to take the low-dose aspirin, ranging from 75 mg to 150 mg.

Over an average follow-up of about 33 months, the researchers found that risk of heart attack, stroke and heart-related death was 15 per cent lower among those who took the 90-mg dose of Brilinta and 16 per cent lower among those who took the 60-mg dose of the drug, compared with those who took the placebo.

Dr Sabatine said that although both ticagrelor doses reduced ischemic events and cardiovascular death compared with placebo, the better choice was the 60-mg dose as it was better tolerated and the bleeding rate was less with it.

Ticagrelor was once touted for its blockbuster potential because it appeared to have a better safety profile than Plavix (clopidogrel) and it had the advantage of being faster acting but also faster to turn off. But its associated bleeding risk did become a problem.

It stumbled on the way to FDA approval and then, in 2013, reports surfaced about problems with the data from the pivotal PLATO trial.

These new findings, while not spectacular, may breathe new life into the drug and appear to make a case for its use in secondary prevention. Yet much of the enthusiasm for extended dual antiplatelet therapy has waned in recent years as data have continued to confirm the bleeding risk, counterbalancing the reduction in thrombotic events also consistently shown with extended therapy.

“The benefit we saw [from Brilinta] was remarkably consistent across the individual components of [heart health events] and in all the major subgroups of patients,” Sabatine said in an ACC news release.