By: Dr. Smitha Hegadi, Medical Analyst, Aissel Solutions
The understanding of platelet biology has yielded several targets which gave new dimensions to management of coronary syndromes. Over the years this understanding resulted in the metamorphosis of treatment of acute coronary syndromes with aspirin and Clopidogrel. But the limitations of this new therapy kept the research live and today we have Tricagrelor, new landmark in the evolution of antiplatelet therapy. Tricagrelor has qualities like faster onset of action, resistant to drug interactions which make it beneficial over the existing standard therapy.
The oral anti-clotting drug Tricagrelor eases risk of death in heart attack patients. FDA approval of tricagrelor to reduce the rate of heart attack (Myocardial Infarction) and cardiovascular death in adult patients with acute coronary syndrome (ACS), as compared to the “Gold Standard” drug “Clopidogrel” is good news for patients in the United States and indicates a significant milestone in the antiplatelet therapy. Tricagrelor (also known as Brilinta), is a treatment for acute coronary syndrome and is indicated to reduce the rate of thrombotic cardiovascular events in patients with unstable angina, non-ST-elevation myocardial infarction, or ST-elevation myocardial infarction.[1]
Brilinta is a first drug of the new chemical class called cyclopentyltriazolopyrimidines (CPTPs) works by inhibiting the development of new atheromas and maintaining blood flow in the body to help decrease a patient's risk of another cardiovascular event such as a heart attack or cardiovascular death. It is a reversibly-binding oral adenosine diphosphate ADP P2Y(12) receptor antagonist,[2] which will be available in 90 mg tablets to be administered with a single 180 mg oral loading dose (two 90 mg tablets) followed by a twice daily, 90 mg maintenance dose. Recent findings from PLATO study (A Study of PLATelet Inhibition and Patient Outcomes), a superiority trial that compared treatment with BRILINTA to another commonly used treatment regimen clopidogrel in 18,624 ACS patients worldwide, demonstrated tricagrelor to be more effective in preventing ischemic events. In those who took a low dose of aspirin along with the drug were less likely to have a cardiovascular episode. Following an initial loading dose of aspirin, BRILINTA should be used with a maintenance dose of 75 mg aspirin once daily. When compared with clopidogrel the drug has shown to slash the risk of death by more than one fifth that is 21%, and of patients suffering another heart attack by 16%.[3]
AstraZeneca is working to help physicians and patients to ensure the bleeding risk and the impact of aspirin dose on the effectiveness of BRILINTA and said the study showed the drug was more effective than Plavix which are necessary before BRILINTA will be available to a considerable number of ACS patients, and will be a key focus for the next 12 months.
As per the research presented at the British Cardiovascular Society Annual Scientific Conference at Manchester in June 2011, the antiplatelet drug can not only prevent the second attack, also can save one in five heart attack victims dying within a year of attack. According to an expert from The University of Sheffield Dr. Robert Storey, Professor of Cardiology and Consultant Cardiologist who was the UK lead for international trials of the drug ticagrelor said, “Many people are dying avoidably in the year after having a heart attack due to delays introducing this new treatment. These new findings provide yet further evidence in support of making the drug available to patients in the UK.’’[4]
Hence the new drug is now approved in 39 countries, including the US, Brazil, Australia, and Canada under the trade name BRILINTA and in the European Union under the trade name BRILIQUE™ and is currently under the supervisory review in 45 more countries, including India, Russia, and China.
Therefore the drug is a revolutionary advance in antiplatelet therapy and is a boon to cardiac patients as every year more than one million Americans succumb to acute coronary syndrome or about one in three patients could have a recurrent heart attack, or die within a year of their first cardiovascular event. After the prolonged trial of about 6 years researchers have eventually found an effective remedy for the most fatal disease suffered worldwide today, which is on the rise.
The understanding of platelet biology has yielded several targets which gave new dimensions to management of coronary syndromes. Over the years this understanding resulted in the metamorphosis of treatment of acute coronary syndromes with aspirin and Clopidogrel. But the limitations of this new therapy kept the research live and today we have Tricagrelor, new landmark in the evolution of antiplatelet therapy. Tricagrelor has qualities like faster onset of action, resistant to drug interactions which make it beneficial over the existing standard therapy.
Brilinta is a first drug of the new chemical class called cyclopentyltriazolopyrimidines (CPTPs) works by inhibiting the development of new atheromas and maintaining blood flow in the body to help decrease a patient's risk of another cardiovascular event such as a heart attack or cardiovascular death. It is a reversibly-binding oral adenosine diphosphate ADP P2Y(12) receptor antagonist,[2] which will be available in 90 mg tablets to be administered with a single 180 mg oral loading dose (two 90 mg tablets) followed by a twice daily, 90 mg maintenance dose. Recent findings from PLATO study (A Study of PLATelet Inhibition and Patient Outcomes), a superiority trial that compared treatment with BRILINTA to another commonly used treatment regimen clopidogrel in 18,624 ACS patients worldwide, demonstrated tricagrelor to be more effective in preventing ischemic events. In those who took a low dose of aspirin along with the drug were less likely to have a cardiovascular episode. Following an initial loading dose of aspirin, BRILINTA should be used with a maintenance dose of 75 mg aspirin once daily. When compared with clopidogrel the drug has shown to slash the risk of death by more than one fifth that is 21%, and of patients suffering another heart attack by 16%.[3]
AstraZeneca is working to help physicians and patients to ensure the bleeding risk and the impact of aspirin dose on the effectiveness of BRILINTA and said the study showed the drug was more effective than Plavix which are necessary before BRILINTA will be available to a considerable number of ACS patients, and will be a key focus for the next 12 months.
As per the research presented at the British Cardiovascular Society Annual Scientific Conference at Manchester in June 2011, the antiplatelet drug can not only prevent the second attack, also can save one in five heart attack victims dying within a year of attack. According to an expert from The University of Sheffield Dr. Robert Storey, Professor of Cardiology and Consultant Cardiologist who was the UK lead for international trials of the drug ticagrelor said, “Many people are dying avoidably in the year after having a heart attack due to delays introducing this new treatment. These new findings provide yet further evidence in support of making the drug available to patients in the UK.’’[4]
Hence the new drug is now approved in 39 countries, including the US, Brazil, Australia, and Canada under the trade name BRILINTA and in the European Union under the trade name BRILIQUE™ and is currently under the supervisory review in 45 more countries, including India, Russia, and China.
Therefore the drug is a revolutionary advance in antiplatelet therapy and is a boon to cardiac patients as every year more than one million Americans succumb to acute coronary syndrome or about one in three patients could have a recurrent heart attack, or die within a year of their first cardiovascular event. After the prolonged trial of about 6 years researchers have eventually found an effective remedy for the most fatal disease suffered worldwide today, which is on the rise.
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[1] FDA News Release, July 20, 2011
[2] Expert Rev Cardiovasc Ther: 2010 Feb;8(2):151-8
[3] N Engl J Med. 2009;361:1045–57
[4] British Cardiovascular Society Annual Scientific Conference, June 2011
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