Abstract 13950: A Head-to-Head Pharmacodynamic Comparison of Prasugrel versus Ticagrelor in Clopidogrel Treated Patients With Coronary Artery Disease: Results of a Prospective Randomized Study
Background: The comparative effects between the P2Y12 receptor inhibitors prasugrel and ticagrelor is a topic of growing interest. To date there are no studies comparing the pharmacodynamic (PD) impact of a loading dose (LD) and maintenance dose (MD) regimen of these agents in a cohort of all-comer patients on clopidogrel therapy.
Methods: This was a prospective, randomized PD study of prasugrel vs ticagrelor in coronary artery disease (CAD) patients on maintenance clopidogrel (75mg/qd) therapy, in adjunct to aspirin (81mg/qd). Patients (n=110) were randomized to switch to prasugrel (60mg LD/10mg MD qd) or ticagrelor (180mg LD/90mg MD bid) for 1 week. PD assessments evaluating the acute (baseline, 30 min, 2 hrs, 24 hrs) and chronic (1 week) effects of therapy were performed. All patients initiated MD 24 hrs after LD of prasugrel (Group P) and ticagrelor (Group T1); a subgroup of T1 patients repeated the acute phase (first 24 hrs) starting the MD 12 hrs after LD (Group T2). The platelet reactivity index (PRI) at 1 week assessed by VASP was the primary endpoint. Other assays included VerifyNow P2Y12 (VN) and light transmittance aggregometry (LTA).
Results: There were no differences in baseline (on-clopidogrel) platelet reactivity. No PD interaction was observed when switching to prasugrel or ticagrelor, which led to a significant reduction in platelet reactivity as early as 30 min and sustained up to 1 week (Figure). There were no differences in VASP-PRI at 1 week (p=0.82; primary endpoint). In the acute phase of treatment, starting ticagrelor MD 12 hrs after LD (T2) was associated with enhanced PD effects compared with initiating 24 hrs after LD (T1). There were no differences between groups over time (ANOVA, p=0.44). Consistent PD findings were found with VN and LTA.
Conclusions: In CAD patients on maintenance clopidogrel therapy, switching to either prasugrel or ticagrelor is associated with prompt, potent, and sustained effects with PD equipoise between the two agents.
Author Disclosures: J. Cho: None. F. Rollini: None. F. Franchi: None. A. Muniz-Lozano: None. C. DeGroat: None. M. Bhatti: None. K. Singh: None. E. Ferrante: None. R.E. Wilson: None. E.C. Dunn: None. M.M. Zenni: None. L.A. Guzman: None. T.A. Bass: None. D.J. Angiolillo: Research Grant; Significant; Bristol Myers Squibb, Sanofi-Aventis, Glaxo Smith Kline, Otsuka, Eli Lilly, Daiichi Sankyo, The Medicines Company, AstraZeneca, Evolva, and Gilead. Honoraria; Significant; Bristol Myers Squibb, Sanofi-Aventis, Eli Lilly, Daiichi Sankyo, The Medicines Company, AstraZeneca, Merck, Evolva, Abbott Vascular, Bayer, and PLx Pharma. Consultant/Advisory Board; Significant; Johnson & Johnson, St. Jude, Sunovion, and CeloNova.
- © 2014 by American Heart Association, Inc.