Real-world incidence of patient-reported dyspnoea with ticagrelor

Abstract

Dyspnoea, a common and multifactorial symptom in patients with acute coronary syndrome, has been associated with lower quality of life and hospital readmission. Prescriber preference for antiplatelet therapy, the standard of care in this patient group, is shifting to ticagrelor due to mortality benefits demonstrated in trials compared with clopidogrel. In these trials, dyspnoea was more commonly reported in patients prescribed ticagrelor but the aetiology is still debated. An observational cohort study was conducted to quantify the rates and severity of dyspnoea reported in patients with acute coronary syndrome and newly prescribed ticagrelor compared with those prescribed clopidogrel. Dyspnoea was more commonly reported in patients prescribed ticagrelor at each follow up post-discharge (p = 0.016). Rates were higher than previously reported in clinical trials. In some patients, dyspnoea necessitated drug therapy change and was associated with readmission to hospital (p = 0.046). As ticagrelor is widely prescribed as a first-line antiplatelet agent for a range of patients with acute coronary syndrome, the incidence of dyspnoea in a generalized patient cohort may result in higher rates of drug discontinuation. This in turn could lead to higher rates of rehospitalisation and potential treatment failure than that reported from the controlled setting of a clinical trial.

Real-World Safety and Efficacy of Ticagrelor in Patients With St Segment Elevation Myocardial Infarction at Assiut University Heart Hospital

“…The incidence of dyspnea of any grade of severity -observed at three months-was consistent with that of the Australian study of the real-world incidence of patient-reported dyspnea with ticagrelor 22 . However, this study reported lower proportions of drug discontinuations; 1.7% versus 7.14%.…”

Invasive and antiplatelet treatment of patients with non‐ST‐segment elevation myocardial infarction: Understanding and addressing the global risk‐treatment paradox

“…Guidelines and hospital protocols should emphasize the importance of documenting patient history, which could affect NSTEMI diagnosis, and of regularly assessing the risks and benefits of therapies to suit the patient's clinical status, which may change over time . Furthermore, guidelines and protocols should include guidance on how to manage patients with dyspnea because some physicians are concerned about dyspnea related to ticagrelor use in their patients, given that dyspnea is more frequently reported in patients with ACS prescribed ticagrelor compared with clopidogrel . The incidence of dyspnea in a real‐world setting has been shown to be greater than that reported in clinical trials and may lead to higher rates of ticagrelor discontinuation .…”

“…73,74 The incidence of dyspnea in a realworld setting has been shown to be greater than that reported in clinical trials and may lead to higher rates of ticagrelor discontinuation. 74 However, given that there is evidence to suggest that dyspnea can resolve during inhibitor use, only in the case of persistent ticagrelor-related dyspnea should drug discontinuation be considered. 73 There is potential for reducing the impact of geographical variation could be a reasonable approach to improve treatment outcomes for patients with NSTEMI, which could be facilitated by existing regional platforms for the management of patients with STEMI.…”

“…Furthermore, guidelines and protocols should include guidance on how to manage patients with dyspnea because some physicians are concerned about dyspnea related to ticagrelor use in their patients, given that dyspnea is more frequently reported in patients with ACS prescribed ticagrelor compared with clopidogrel . The incidence of dyspnea in a real‐world setting has been shown to be greater than that reported in clinical trials and may lead to higher rates of ticagrelor discontinuation . However, given that there is evidence to suggest that dyspnea can resolve during inhibitor use, only in the case of persistent ticagrelor‐related dyspnea should drug discontinuation be considered …”

Effects of oral administration of ticagrelor on the plasma level of adrenaline, histamine, serotonin, and acetylcholine in rat

“…The reported incidence of ticagrelor-related dyspnoea in PHILO trial and in SOCRATES was 5.7% and 6.2%, respectively [4] . A real-world study showed that the incidence of patient-reported dyspnoea with ticagrelor was 56.0% at 3 week [5] . In recent years, some case reports and retrospective studies have shown that dyspnea associated with ticagrelor occurs not only in the early stages of drug treatment, but also may cause delayed dyspnea and even more dangerous Cheyne-Stokes (CSR) [6,7,8] .…”