New Drug Update 2010-2011 Faculty Disclaimer - CME Conferences

2 nd Annual Essentials in Primary Care
Fall Conference
Friday, November 11, 2011
Ticagrelor – Brilinta
N Engl J Med 2009;361:1045-57
Endpoint
Primary Composite
(CV death, MI, CVA)
Secondary Endpoints
Ticagrelor
N=9333
Clopidogrel
N=9291
Hazard Ratio
(95% CI)
9.8% 11.7% 0.84
(0.77-0.92)
CV death 4.0% 5.1% 0.79
(0.69-0.91)
MI 5.8% 6.9% 0.84
(0.75-0.95)
Stroke 1.5% 1.3% 1.17
(0.91-1.52)
All cause mortality 4.5% 5.9% 0.78
(0.69-0.89)
In-stent thrombosis
(11,289 pts with
PCI/stenting)
1.3% 1.9% 0.67
(0.50-0.91)
P-value ARR/NNT
0.0003 1.9%/53
0.0013 1.1%/91
0.0045 1.1%/91
0.22
0.0003 1.4%/72
0.0091 0.6%/167
Ticagrelor – Brilinta
N Engl J Med 2009;361:1045-57.
• No significant difference in the rates of major bleeding
was found between the ticagrelor and clopidogrel
groups (11.6% and 11.2%, respectively; P = 0.43)
• Ticagrelor was associated with a higher rate of major
bleeding not related to coronary-artery bypass grafting
(4.5% vs. 3.8%, P = 0.03, ARI = 0.7%, NNH = 143)
including more instances of fatal intracranial bleeding
and fewer of fatal bleeding of other types.
• In a genetic substudy of PLATO (n=10,285), the effects
of ticagrelor compared to clopidogrel on thrombotic
events and bleeding were not significantly affected by
CYP2C19 genotype.
Wayne Weart
New Drug Update Part I