Ticagrelor Improves Outcomes After Myocardial Infarction

January 14th, 2015

Ticagrelor Improves Outcomes After Myocardial Infarction

Larry Husten, PHD

For the first time, a very large trial has shown that dual antiplatelet therapy (DAPT) improves cardiovascular outcomes when given to patients 1 to 3 years after a myocardial infarction. Because DAPT has been shown previously to reduce the high risk of recurrent events for up to a year following an MI, it is considered to be standard therapy during this time period. But whether or not longer-term treatment after a year would be also beneficial has been controversial.

AstraZeneca today announced that the Pegasus-TIMI 54 study had successfully reached its primary endpoint. More than 21,000 patients were randomized to receive either ticagrelor (Brilinta, 60 or 90 mg twice daily) or placebo in addition to aspirin. Therapy was initiated 1 to 3 years after MI in patients who also had one additional risk factor. The primary endpoint was the composite of cardiovascular death, MI, or stroke. The company said that no safety issues had been found and that the full results of the trial would be presented later this year.

Pegasus-TIMI 54 is the second in a series of trials sponsored by AstraZeneca exploring a broad range of indications for ticagrelor. PLATO, the first trial, earned FDA approval of the drug for an ACS indication, but the drug has labored under intense criticism of the trial. In recent months, some of this criticism has started to resolve. Additional trials are now underway testing ticagrelor’s role in patients with peripheral arterial disease, with ischemic stroke or TIA, and with diabetes and coronary atherosclerosis.

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January 14th, 2015