ESC 2017: Subanalysis of PEGASUS shows ticagrelor reduces cardiovascular death by 29% in patients with prior myocardial infarction


A new subanalysis from the phase III PEGASUS-TIMI 54 trial, which was presented at the European Society of Cardiology (ESC) congress (26–30 August, Barcelona, Spain), indicates that 60mg twice daily ticagrelor (Brilinta, AstraZeneca) is associated with a 29% risk reduction in cardiovascular death (p=0.0041)—compared with placebo—in patients taking low-dose aspirin who are still at high risk of an atherothrombotic event.

In the study, a press release reports, patients received Brilinta within two years of a myocardial infarction or within one year of stopping antiplatelet treatment with an adenosine diphosphate (ADP) inhibitor. The latest results highlight a potential protective cardiovascular benefit associated with longer-term treatment vs. the standard 12-month post-event treatment period with ticagrelor 60mg.

The favourable benefit-risk ratio for extended dual antiplatelet treatment the drug was suggested earlier in the PEGASUS trial that provided the data supporting the European Medicines Agency’s approval of ticagrelor in the post-myocardial infarction indication.

The subanalysis also showed a risk reduction of 20% in all causes of death, and 20% in the composite of cardiovascular death death, myocardial infarction or stroke. As expected, major bleeding rates were consistent with the known safety profile of ticagrelor.

Mikael Dellborg (University of Gothenburg, Gothenburg, Sweden), a member of the Steering Committee of the PEGASUS-TIMI 54 trial, says: “The conclusion for both clinicians and patients at high-risk of CV death post-MI is clear—treatment with ticagrelor 60mg, either as continuation therapy after the initial 12 month post-event period, or with as limited interruption as possible, is associated with a clear and favourable benefit-risk ratio for this population of patients. This new insight is potentially practice-changing, as while more than seven million people worldwide suffer a heart attack each year, we know that fewer than half receive adequate long-term treatment to reduce their risk of further cardiovascular events.”


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