Comparative Effectiveness and Safety Analysis of Dual Antiplatelet Therapies Within an Integrated Delivery System

Coons, James C.; Iasella, Carlo J.; Chanas, Tyler; Wang, Nan; Williams, Kiersten; Boyd, Angela R.; Lyons, John; Eckardt, Jamie; Rihtarchik, Lindsey; Merkel, Alison; Chambers, Alexandra; Lemon, Lara; Smith, Randall; Ensor, Christopher R.

doi:10.1177/1060028017706977

Cited by 6 publications

(7 citation statements)

References 18 publications

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“…For example, Larmore et al found that major adverse cardiovascular and major bleeding events were lower at 30‐days in the prasugrel‐treated group when compared to the ticagrelor‐treated group in patients with ACS treated with PCI 18 . However, most observational studies found no significant difference in the incidence of adverse cardiovascular and bleeding events when comparing ticagrelor and prasugrel in patients with ACS 7–11 . Our ITT sensitivity analysis provided results that were consistent with recent observational studies evaluating prasugrel and ticagrelor and that were contrary to the findings from the ISAR‐REACT 5 trial.…”

Section: Discussionsupporting

confidence: 85%

“…The observational literature evaluating outcomes of antiplatelet use in patients with ACS undergoing PCI has shown conflicting results 5–9,18,28 . Differences in how study designs address variability in follow‐up time, inclusion, and exclusion criteria, approaches for addressing covariates may lead to divergent conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…The Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR‐REACT) 5 trial, a randomized, open‐label study evaluating ticagrelor versus prasugrel in patients with ACS in whom an invasive evaluation was planned, found that patients receiving ticagrelor had a significantly higher incidence of death, myocardial infarction, or stroke but similar rates of major bleeding over 1 year of follow‐up 4 . Observational studies comparing ticagrelor and prasugrel in this setting have yielded contradictory results 5–9 but have not taken into account the possibility of differential censoring (eg, for treatment switching or insurance disenrollment)or confounding by time‐dependent factors, both of which can affect study outcomes 10 …”

Section: Introductionmentioning

confidence: 99%

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Comparative effectiveness and safety of prasugrel versus ticagrelor following percutaneous coronary intervention: An observational study

et al. 2021

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Background Observational studies comparing ticagrelor and prasugrel in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) have yielded contradictory results, but these studies often did not consider differential censoring (eg, for treatment switching or insurance disenrollment) or confounding by time‐dependent factors. Objective Our objective was to conduct a comparative effectiveness and safety analysis of ticagrelor and prasugrel in patients who underwent PCI after being hospitalized for an ACS. Methods This study used the Optum's de‐identified Clinformatics® Data Mart Database and included patients aged 18 years or older with an index hospital admission between May 2012 and September 2015, a diagnosis of ACS managed with PCI, and treatment with either ticagrelor or prasugrel. The primary composite outcome was defined as the first occurrence of all‐cause death, myocardial infarction (MI), or ischemic stroke. The secondary composite outcome included the first occurrence of gastrointestinal (GI) bleed, intracranial hemorrhage (ICH), or other major bleeds requiring hospitalization. Weighted Cox proportional hazard models and robust variance estimation were implemented to adjust for baseline comorbidities, time‐varying exposure, time‐dependent confounders, and differential censoring. Results Included in the analysis were 2559 patients initiated on ticagrelor and 4456 patients initiated on prasugrel following PCI. Patients initiated on ticagrelor were 10% more likely to have eligibility disenrollment (Ticagrelor: 57%, Prasugrel: 47%, p < 0.01) and 7 percentage‐points more likely to switch medication (Ticagrelor: 35%, Prasugrel: 28%, p < 0.01). After adjusting for multiple factors, including time‐varying exposure and censoring imbalance, ticagrelor was associated with a higher risk of all‐cause death, MI, or stroke when compared to prasugrel (Hazard ratio (HR): 1.33; 95% CI: 1.04–1.68). Similarly, ticagrelor was associated with a higher risk in bleeding events when compared with prasugrel (HR: 1.61; 95% CI: 1.19–2.17). Conclusion When compared with ticagrelor, prasugrel use following PCI for ACS was associated with a lower risk of death, MI, or stroke, as well as a reduced risk of major bleeding.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparative effectiveness and safety of prasugrel versus ticagrelor following percutaneous coronary intervention: An observational study

et al. 2021

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“…Two manuscripts were published in peer-reviewed journals and four others were either under review or in the manuscript development phase as of fall 2019. 10,11…”

Section: Resultsmentioning

confidence: 99%

A Pharmacotherapy Scholars Program to Provide Intensive Training to Enhance Pharmacy Students’ Postgraduate Readiness

Coons

Benedict

Seybert

et al. 2019

American Journal of Pharmaceutical Education

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Objective. To design, integrate the curriculum for, and evaluate an innovative program to facilitate placement of students into postgraduate pharmacy residency training programs involving direct patient care. Methods. The Pharmacotherapy Scholars Program (PSP) was designed to prepare fourth-professional year students to become highly proficient in a direct patient care role and to successfully match with postgraduate residency training programs. The following elements were included in the year-long curriculum: integrated synchronous advanced pharmacy practice experiences with personal advising, teambased mentoring, peer-to-peer learning, longitudinal research, and professional development. Program goals were modeled after the accreditation standards for postgraduate year one (PGY1) pharmacy residency programs. Program faculty members ensured that the PSP had a broad scope, included rigorous student assessments, had a strong research focus, and provided scholarship opportunities. Results. Sixty-eight students completed the program from fall 2013 through spring 2019. The overall residency match rate was 93%. Students' performance on both knowledge and clinical skills assessments significantly improved after completing the program. There was an approximately 15% increase in knowledge and a 30% improvement in clinical skills based on comprehensive readiness assessments and an intermittent clinical examination that used patient simulation, respectively. Conclusion. The Pharmacotherapy Scholars Program is an innovative training program designed to enhance PharmD students' preparation for advanced clinical training. Students who completed the PSP achieved a high PGY1 residency placement rate while demonstrating significant improvements in pharmacotherapy knowledge and clinical skills in direct patient care activities.

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“…Taking ticagrelor as example, the landmark trial PLATO demonstrated that ticagrelor, compared to clopidogrel, reduced MACE (HR 0.84, 95% CI 0.77–0.92), MI (HR 0.84, 95% CI 0.75–0.95), vascular death (HR 0.79, 95% CI 0.69–0.91) and all‐cause death (HR 0.78, 95% CI 0.69–0.89) at 1 year 6 . Coons et al reported in a study of 8127 post‐PCI subjects that ticagrelor did not show reduced MACE compared to clopidogrel (HR 1.05, 95% CI 0.52–2.13) at 1 year 11 . A comparative observational study in Greece using Greek antiplatelet (GRAPE) registry showed only reduction of all‐cause death using prasugrel/ticagrelor compared to clopidogrel at 1 year (HR 0.61, 95% CI 0.38–0.98), but not MI (HR 0.65, 95% CI 0.27–1.57) or stroke (HR 1.03, 95% CI 0.53–2.00) 12 .…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety comparing prasugrel/ticagrelor and clopidogrel in Hong Kong post‐acute coronary syndrome patients–A 10‐year cohort study

Lam

Yan

Lee

2021

Clinical Cardiology

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Background Clinical evidence of prasugrel/ticagrelor in dual antiplatelet therapy (DAPT) in Asian acute coronary syndrome (ACS) population remains inconclusive. We aimed to compare the clinical efficacy and safety of prasugrel/ticagrelor compared to clopidogrel as part of DAPT in Hong Kong ACS population for 10 years. Hypothesis Prasugrel/ticagrelor, compared to clopidogrel, reduces risk of major adverse cardiovascular event (MACE) in Hong Kong ACS population. Methods The retrospective observational cohort study included patients admitted to seven institutions under Hospital Authority Hong Kong with diagnosis of ACS during 2008–2017. Risk of MACE, defined as composite of cardiovascular (CV) death, non‐fatal myocardial infarction (MI) and non‐fatal stroke, and risk of any bleeding leading to hospitalization were examined. Baseline characteristics difference was adjusted by propensity score (PS) matching. Adjusted Cox regression model was used to estimate hazard ratio of interested outcome. Results In PS matched cohort including 944 patients in each group, MACE risk reduction of 40% from 1 year to 5 years after index ACS event was observed in prasugrel/ticagrelor group (HR 0.60, 95% CI 0.39–0.91, p = .015). The risk reduction was highly driven by MI reduction (HR 0.54, 95% CI 0.33–0.91, p = .019). Lower bleeding risk was observed in prasugrel/ticagrelor group compared to clopidogrel from 1 year to 5 years (HR 0.46, 95% CI 0.21–1.00, p = .051). Conclusions Prasugrel/ticagrelor showed MACE risk reduction over clopidogrel as part of DAPT up to 5 years after index event, while prasugrel/ticagrelor was not associated with increased bleeding risk.

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Comparative Effectiveness and Safety Analysis of Dual Antiplatelet Therapies Within an Integrated Delivery System

Abstract: Dual antiplatelet therapies differed in both MACE and bleeds in a real-world setting of PCI. Prasugrel was associated with fewer MACE, whereas clopidogrel had fewer major bleeding events.

Cited by 6 publications

References 18 publications

Comparative effectiveness and safety of prasugrel versus ticagrelor following percutaneous coronary intervention: An observational study

Comparative effectiveness and safety of prasugrel versus ticagrelor following percutaneous coronary intervention: An observational study

A Pharmacotherapy Scholars Program to Provide Intensive Training to Enhance Pharmacy Students’ Postgraduate Readiness

Efficacy and safety comparing prasugrel/ticagrelor and clopidogrel in Hong Kong post‐acute coronary syndrome patients–A 10‐year cohort study

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