For STEMI, ticagrelor ties clopidogrel for 12-month safety, efficacy: TREAT

  • Berwanger O & al.
  • J Am Coll Cardiol
  • 12 Mar 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • For patients with ST-elevation myocardial infarction (STEMI) treated with fibrinolytic therapy, ticagrelor (Brilinta, Amneal) showed similar safety and efficacy to clopidogrel (Plavix, Bristol-Myers Squibb) at 12 months. 
  • Result is exploratory.
  • Editorial performed meta-analysis of TREAT and PLATO, linking ticagrelor to 13% relative risk reduction of cardiovascular death, myocardial infarction, or stroke in patients with STEMI.

Why this matters

  • Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel reduces major cardiovascular events in patients with STEMI.
  • Ticagrelor acts faster and offers better P2Y12 inhibition vs clopidogrel.
  • PLATO demonstrated lower rate of cardiovascular events with ticagrelor after primary percutaneous coronary intervention (PCI) in a STEMI population not treated with fibrinolytics.
  • TREAT has already reported acceptable 30-day safety results.

Key results

  • Ticagrelor vs clopidogrel:
    • Primary outcome: 6.7% (129/1913) vs 7.3% (137/1886); HR, 0.93 (95% CI, 0.73-1.18; P=.53).
    • Dyspnea: 23.9% vs 13.7%.
    • Similar between-group rate of major, fatal, and intracranial bleeding.
    • Minor bleeding more frequent with ticagrelor.

Study design

  • International, multicenter, randomized, open-label TREAT (n=3799).
  • Participants aged
  • They were randomly assigned to daily ticagrelor vs clopidogrel.
  • Outcome: 12-month composite of cardiovascular mortality, myocardial infarction, or stroke.
  • Funding: AstraZeneca.

Limitations

  • Underpowered to assess 12-month efficacy.
  • Older patients excluded.
  • Open-label.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit