Efficacy of Platelet Inhibitors Compared in Diabetes Patients with CAD
In patients with diabetes mellitus with coronary artery disease, ticagrelor provided similar or greater inhibition of ADP-induced platelet reactivity vs. prasugrel in the acute and chronic phases of treatment, an article in Circulation reported.
Prasugrel and ticagrelor have been shown to decrease thrombotic complications to a greater extent than clopidogrel. Some analyses that evaluated prasugrel and ticagrelor vs. clopidogrel showed diabetes patients to have benefits that were consistent with the overall study populations, although the magnitude of the ischemic risk reduction seemed more profound with prasugrel. To better examine this effect, study authors conducted a prospective, randomized, double-blind, double-dummy, cross-over pharmacodynamic study enrolling 50 aspirin-treated diabetes patients with coronary artery disease.
Study patients were randomized to receive prasugrel (60mg loading dose + 10mg maintenance dose daily) or ticagrelor (180mg loading dose + 90mg maintenance dose twice daily) for 1 week. Acute effects at baseline, 30 mins, and 2 hours post-loading dose and maintenance effects at 1 week were assessed. The study's primary endpoint was the comparison of P2Y12 reaction units (PRU) as determined by VerifyNow P2Y12 at 1-week between prasugrel vs. ticagrelor.
The data indicated both prasugrel and ticagrelor doses significantly reduced ADP- and non-ADP-induced measures of platelet reactivity. PRU were similar between prasugrel and ticagrelor at 30 minutes and 2 hours post-loading dose. At 1 week, PRU was significantly lower with ticagrelor vs. prasugrel (52 vs. 83, least squares mean difference –31, 95% CI: –57 to –4; P=0.022). Pharmacodynamic assessments measured by VASP, light transmittance aggregometry and Multiplate were also similar between prasugrel and ticagrelor at each time point. Study authors also noted rates of high on-treatment platelet reactivity were similar between groups with all assays for all time points.
Although the inhibition of measures of non-ADP-induced platelet reactivity did not significantly differ between the two agents, ticagrelor showed similar or greater inhibition of ADP-induced platelet reactivity compared to prasugrel.
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