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Ticagrelor Versus Clopidogrel in Black Patients With Stable Coronary Artery Disease: Prospective, Randomized,
Ron Waksman1, Juan Maya2, Dominick J Angiolillo2
1From the Section of Interventional Cardiology, MedStar Washington Hospital Center (R.W.); GFC, Global Medicines Development, AstraZeneca LP, Wilmington, DE (J.M., G.F.C., R.T., R.J.C.); Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL (D.J.A.); and Heart and Vascular Institute, Tulane University, New Orleans, LA (K.C.F.). ron.waksman@medstar.net.
Insights
In black patients with coronary artery disease (CAD), ticagrelor demonstrated superior platelet inhibition compared to clopidogrel. This study evaluated antiplatelet efficacy in this population, finding ticagrelor offered faster and greater platelet reduction.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Coronary artery disease (CAD) poses a significant health burden in Black populations.
- There is a critical need for research into antiplatelet agents specifically within this demographic.
- This study addresses the efficacy of ticagrelor versus clopidogrel in Black patients with stable CAD on low-dose aspirin.
Purpose of the Study:
- To compare platelet reactivity during loading and maintenance doses of ticagrelor and clopidogrel.
- To evaluate the pharmacokinetic profile of ticagrelor and its metabolite AR-C124910XX.
- To assess these parameters in Black patients with stable CAD receiving low-dose aspirin.
Main Methods:
- A multicenter, randomized, open-label, crossover study involving 34 Black patients with stable CAD.
- Patients received low-dose aspirin (75-100 mg/d) and were randomized to clopidogrel or ticagrelor regimens for 7-9 days, followed by a crossover after a 10-14 day washout period.
- Platelet reactivity was measured using the VerifyNow P2Y12 assay, with the primary endpoint being platelet reactivity 2 hours post-loading dose (PRU).
Main Results:
- Ticagrelor showed significantly lower least-squares mean PRU (27.6) at 2 hours post-loading dose compared to clopidogrel (211.2; P<0.001).
- Ticagrelor resulted in a statistically greater percent reduction in PRU from baseline at all time points.
- The prevalence of high on-treatment platelet reactivity (≥208 PRU) was 0% with ticagrelor versus 57.1% with clopidogrel at 2 hours post-dose.
Conclusions:
- Ticagrelor provides a faster onset and a greater degree of platelet inhibition than clopidogrel in Black patients with stable CAD on low-dose aspirin.
- These findings highlight ticagrelor's potential as a more effective antiplatelet strategy in this specific patient group.
- Pharmacokinetic data for ticagrelor and its metabolite were consistent with prior studies.
Background:
The burden of coronary artery disease (CAD) is high in blacks, highlighting the need for clinical research of antiplatelet agents in this population. We sought to evaluate platelet reactivity during loading and maintenance dosing of ticagrelor versus clopidogrel, and the pharmacokinetic profile of ticagrelor and its metabolite AR-C124910XX, in black patients with stable CAD taking low-dose aspirin (acetylsalicylic acid).
Methods And Results:
In a multicenter, randomized, open-label, crossover study, 34 blacks with stable CAD receiving acetylsalicylic acid 75 to 100 mg/d were randomized to clopidogrel (600 mg, then 75 mg QD for 7-9 days) or ticagrelor (180 mg, then 90 mg BID for 7-9 days). After washout 10 to 14 days, patients switched regimens. The primary end point was platelet reactivity 2 hours post loading dose (P2Y12 reactivity units [PRU] measured by the VerifyNow assay). Least-squares mean PRU at 2 hours post loading dose was lower with ticagrelor (27.6) versus clopidogrel (211.2); least-squares mean difference was -183.6 (95% confidence interval, -213.9 to -153.3; P<0.001). At all time points, the least-squares mean PRU was significantly lower, and the percent reduction in PRU from baseline was statistically greater, with ticagrelor versus clopidogrel. At 2 hours post dose, the prevalence of high on-treatment platelet reactivity (≥208 PRU) was lower with ticagrelor (0%) than with clopidogrel (57.1%). Pharmacokinetic profiles of ticagrelor and AR-C124910XX were consistent with previous reports in stable CAD populations.
Conclusions:
In black patients with stable CAD receiving low-dose acetylsalicylic acid, ticagrelor provided a faster onset and greater degree of platelet inhibition than clopidogrel.
Clinical Trial Registration:
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01523392.
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