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One-Year Clinical Effectiveness Comparison of Prasugrel with Ticagrelor: Results from a Retrospective Observational Study using an Integrated Claims Database

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Abstract

Background

No direct comparisons of ticagrelor and prasugrel with 1-year clinical follow-up have been reported.

Objectives

Our objective was to compare 1-year clinical outcomes among patients with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI) and treated with either ticagrelor or prasugrel in a real-world setting.

Methods

This retrospective study included patients from a payer database who were aged ≥18 years and had ACS managed with PCI with no history of transient ischemic attack (TIA)/stroke. Data were propensity matched for prasugrel use with a 3:1 prasugrel:ticagrelor ratio. Post-discharge net adverse clinical event (NACE) rate at 1 year was evaluated for noninferiority using a pre-defined 20% margin. NACE was a composite of major adverse cardiovascular events (MACE) or rehospitalization for bleeding.

Results

In total, 15,788 ACS-PCI patients were included (prasugrel 12,797; ticagrelor 2991). Prasugrel-treated patients were younger; less likely to be female, have prior myocardial infarction (MI), diabetes, or non-ST-segment elevation MI (NSTEMI); and more likely to have unstable angina (UA) than ticagrelor-treated patients. Prior to matching, NACE and MACE (P < 0.01) were lower, with no difference in bleeding with prasugrel compared with ticagrelor. After matching, there was no significant difference in baseline characteristics. Noninferiority was demonstrated for NACE, MACE, and bleeding between prasugrel and ticagrelor. NACE and MACE were significantly lower with prasugrel use, primarily driven by heart failure, with no significant difference in all-cause death, MI, UA, revascularization, TIA/stroke, or bleeding.

Conclusions

In this retrospective study, physicians preferentially used prasugrel rather than ticagrelor in younger ACS-PCI patients with lower risk of bleeding or comorbidities. After propensity matching, clinical outcomes associated with prasugrel were noninferior to those with ticagrelor.

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Acknowledgements

The authors thank Doug Faries, PhD, Hsiao Lieu, MD, Molly Tomlin, MS, Nayan Acharya, MD (deceased), and Vladimir Kryzhanovski, MD, at Eli Lilly and Company; Feride Frech-Tamas, PhD, Elizabeth Marrett, MPH, and Qiaoyi Zhang, PhD, at Daiichi Sankyo Inc.; and Teresa Bennett and Jaime Lucove at Symphony Health Solutions, for valuable contributions to this study and manuscript.

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Authors and Affiliations

  1. Department of Cardiovascular Diseases, Ochsner Clinical School, John Ochsner Heart and Vascular Institute, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA, 70121, USA

    Mark B. Effron

  2. Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, 80045, USA

    Kavita V. Nair & Robert L. Page II

  3. Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, 46285, USA

    Mark B. Effron, Cliff Molife, Stuart Y. Keller, Yajun Zhu & Patrick L. McCollam

  4. Evidera, 430 Bedford Street, Suite 300, Lexington, MA, 02420, USA

    Jason C. Simeone, Brian Murphy & Beth L. Nordstrom

  5. Allied Health Professions School, Virginia Commonwealth University, Richmond, VA, 23219, USA

    George W. Vetrovec

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  1. Mark B. Effron
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Corresponding author

Correspondence to Mark B. Effron.

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Funding

This study was funded by Daiichi Sankyo Inc., Parsippany, NJ, USA, and Eli Lilly and Company, Indianapolis, IN, USA.

Conflict of interest

MBE is a shareholder of, receives a pension from, and—at the time of the study—was an employee of Eli Lilly and Company. CM, SK, YZ, and PLM are shareholders and employees of Eli Lilly and Company. GV is an unpaid consultant to Daiichi Sankyo and Eli Lilly. KVN and RLP II are paid consultants to Daiichi Sankyo and Eli Lilly. JCS, BLN, and BM are employed by Evidera, which received funding from Eli Lilly and Company and Daiichi Sankyo Inc. to conduct this research.

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Effron, M.B., Nair, K.V., Molife, C. et al. One-Year Clinical Effectiveness Comparison of Prasugrel with Ticagrelor: Results from a Retrospective Observational Study using an Integrated Claims Database. Am J Cardiovasc Drugs 18, 129–141 (2018). https://doi.org/10.1007/s40256-017-0255-y

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