Ticagrelor equivalent to clopidogrel in peripheral artery disease
medwireNews: Ticagrelor is not superior to clopidogrel for the reduction of cardiovascular events in patients with symptomatic peripheral artery disease (PAD), results of the EUCLID trial suggest.
Over a median follow-up of 30 months, cardiovascular events – defined as a composite endpoint of cardiovascular death, myocardial infarction, or ischemic stroke – occurred in 10.8% of 6930 patients receiving ticagrelor, and in 10.6% of 6955 receiving clopidogrel, with a nonsignificant hazard ratio (HR) of 1.02.
When the individual components of the composite endpoint were analyzed separately, ticagrelor treatment resulted in a significantly lower rate of ischemic stroke than clopidogrel, at 1.9% versus 2.4% of patients (HR=0.78).
The results were presented by Manesh Patel (Duke University Medical Center, Durham, North Carolina, USA) at the American Heart Association (AHA) Scientific Sessions 2016 meeting, held in New Orleans, Louisiana, USA, and published simultaneously in The New England Journal of Medicine.
Commenting on the study, Carl Pepine (University of Florida, Gainesville, USA) told the press that “ticagrelor has proven superior to clopidogrel in several coronary trials.”
He added: “In PAD patients, the same result was found with clopidogrel and ticagrelor in terms of preventing events, and there was a very interesting signal for stroke reduction.”
The incidence of limb ischemia and revascularization was similar in the ticagrelor and clopidogrel groups, with corresponding rates of 1.7% versus 1.7% and 12.2% versus 12.8%. There was no difference in the risk of major bleeding between the two groups.
A similar proportion of patients in each group discontinued due to adverse events, but significantly more patients taking ticagrelor than clopidogrel discontinued due to dyspnea or minor bleeding, at a respective 4.8% versus 0.8% and 2.4% versus 1.6%.
The study authors note that dyspnea and minor bleeding “are well-described adverse effects of the drug.”
Rates of treatment discontinuation for any reason were significantly higher with ticagrelor than with clopidogrel (30.1 vs 25.9%, HR=1.21).
Prior to the present study, “[t]here have been no large trials focusing on patients with peripheral artery disease, which has led to limited direct evidence to support any guideline recommendations for specific antiplatelet therapies in such patients,” write Patel and colleagues.
The EUCLID trial involved 13,885 patients with symptomatic PAD from 811 sites in 28 countries who were randomly assigned to receive either ticagrelor (90 mg twice daily) or clopidogrel (75 mg once daily).
Looking to the future, Pepine said that “clearly many knowledge gaps remain relative to PAD,” and more studies like EUCLID are needed to determine the optimal antiplatelet regimen for these patients.
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