November 13, 2016
Ticagrelor No Better Than Clopidogrel in Patients with Symptomatic Peripheral Artery Disease.Harlan M. Krumholz, MD, SM reviewing Hiatt WR et al. N Engl J Med 2016 Nov 13.
Findings from the EUCLID trial do not support use of the higher-cost platelet inhibitor in this clinical context.
Ticagrelor is a more expensive platelet inhibitor than clopidogrel, prompting ticagrelor's manufacturer to sponsor comparative-effectiveness studies. In the EUCLID trial, 13,885 people (median age, 66; 72% men) with symptomatic peripheral artery disease (PAD) were randomized, in double-blind fashion, to receive ticagrelor (90 mg twice daily) or clopidogrel (75 mg once daily). About three quarters of the participants were taking statins.
During a median follow-up of 30 months, incidence of the primary endpoint — cardiovascular death, myocardial infarction, or ischemic stroke — was statistically similar with ticagrelor and clopidogrel, both overall (10.8% and 10.6%, respectively) and in most prespecified subgroups. Secondary outcomes were also similar with the two drugs, as was the incidence of major bleeding. Discontinuation related to adverse effects was significantly more common with ticagrelor than clopidogrel.
COMMENT
This randomized trial provides no support for ticagrelor over clopidogrel in patients with symptomatic PAD. The findings also raise the broader question of whether ticagrelor should have any role in secondary prevention.
EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Harlan M. Krumholz, MD, SM at time of publication
Consultant / Advisory boardUnited Healthcare (Advisory Board); Element Science (Consultant)
EquityImageCor; Hugo PHR
Grant / Research supportAgency for Healthcare Research and Quality; Food and Drug Administration; National Heart, Lung, and Blood Institute; Robert Wood Johnson Foundation; Medtronic; Johnson & Johnson; Chinese National Center for Cardiovascular Disease; Centers for Medicare & Medicaid Services
Editorial boardsBMJ.com/US; American Journal of Managed Care; American Journal of Medicine; Archives of Medical Science; Critical Pathways in Cardiology; Current Cardiovascular Risk Reports; JACC: Cardiovascular Imaging; Circulation: Cardiovascular Quality and Outcomes; Circulation (Associate Editor)
CITATION(S):
Hiatt WR et al.
Ticagrelor versus clopidogrel in symptomatic peripheral artery disease. N Engl J Med 2016 Nov 13; [e-pub]. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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