Prasugrel 5mg tablets

Importance: In patients with acute coronary syndrome (ACS) undergoing invasive treatment, ticagrelor and prasugrel are guideline-recommended P2Y12 receptor inhibitors. The ISAR-REACT5 randomized clinical trial demonstrated superiority for prasugrel, although concerns were raised about the generalizability of some underpowered subgroup analyses. Objectives: To emulate a randomized clinical trial evaluating the safety and effectiveness of ticagrelor vs prasugrel under the conditions of routine care in individuals with ACS planned to undergo an invasive treatment strategy. Design, Setting, and Participants: This new-user cohort study included secondary data from a German statutory health insurance claims database between January 2012 and December 2021, using 1:1 propensity score nearest-neighbor matching to emulate ISAR-REACT5. Individuals with ACS receiving either ticagrelor or prasugrel treatment after hospital discharge were followed up for 1 year. Eligibility criteria closely emulated those of ISAR-REACT5 and included age of 18 years or older and cardiovascular risk factors. Data were analyzed from May 2023 to May 2024. Exposure: Outpatient prescription of ticagrelor or prasugrel. Main Outcomes and Measures: The primary end point was the composite of all-cause mortality, myocardial infarction (MI), or stroke within 1 year of outpatient treatment initiation. Secondary end points included individual components of the primary end point and stent thrombosis. The safety end point was major bleeding. A Cox proportional hazards regression model was fitted to the overall cohort. Results: Of 17 642 propensity score-matched individuals (mean [SD] age, 63.1 [10.9] years; 73.9% male), 8821 received ticagrelor and 8821 received prasugrel. Agreement was met in 11 of 12 predefined agreement metrics when comparing the results with ISAR-REACT5. The primary composite end point of all-cause mortality, MI, or stroke occurred in 815 individuals (9.2%) receiving ticagrelor and 663 (7.5%) receiving prasugrel (hazard ratio [HR], 1.24; 95% CI, 1.12-1.37). Myocardial infarction (HR, 1.20; 95% CI, 1.06-1.36) and stroke (HR, 1.33; 95% CI, 1.02-1.74) each occurred significantly more often in the ticagrelor group. Analysis of all-cause mortality (HR, 1.27; 95% CI, 0.99-1.64), stent thrombosis (HR, 1.11; 95% CI, 0.89-1.30), and major bleeding (HR, 1.12; 95% CI, 0.96-1.32) revealed no significant differences between treatment groups. Subgroup analysis showed that prasugrel was associated with the primary composite end point in fewer individuals with ST-segment elevation MI (338 of 4941 [6.8%] vs 451 of 4852 [9.3%]). Conclusions and Relevance: This cohort study found that prasugrel was associated with lower rates of all-cause mortality, MI, or stroke compared with ticagrelor in individuals with ACS undergoing an invasive treatment strategy in routine care, particularly in individuals with ST-segment elevation MI. The findings suggest that carefully designed database studies can complement and extend findings from randomized clinical trials, informing guidelines and clinical decision-making.

Abstract licence: CC BY

Abstract Background: Reperfusion can be done through primary percutaneous coronary intervention (PPCI) and thrombolytic administration. Patients with myocardial infarction should receive antiplatelet drugs from the P2Y12 receptor inhibitor category (such as ticagrelor, prasugrel, and clopidogrel). Based on recent researches, effectiveness of ticagrelor versus clopidogrel is still debatable. Methods: A total of 128 patients who underwent PPCI, divided into two groups (Zyllt ® group (600 mg received as a loading dose, maintenance with dose of 75 mg daily)) and Ticora ® group (180 mg as a loading dose, maintenance with dose of 90 mg twice). Both the groups received aspirin 80 mg daily, too. They were followed up after 3 months. Results: In this study, 86.9% were men, and there was no significant difference in terms of gender and age in 2 groups. Risk factors, type of myocardial infraction (MI), number of involved and infarct-related arteries, and presence of complications and their type were not statistically different in groups ( P > 0.05). Among all complications, only one person had dyspnea in the Ticora group, one patient in the Ticora group, and 3 patients in the Zyllt group had chest pain. The difference in “TIMI Score” during Time was significant ( P = 0.037). Conclusion: Our study shows no difference between ticagrelor and clopidogrel after PPCI in patients with MI in terms of risk factors, type of MI, number of involved and infarct-related arteries, and presence of complications and their type, in two studied groups.

Abstract licence: CC BY-NC-SA