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Platelet inhibition higher with ticagrelor for patients with diabetes
In a pharmacodynamic comparison of ticagrelor and prasugrel in patients with type 2 diabetes and ACS undergoing PCI, ticagrelor was associated with stronger platelet inhibition than prasugrel.
“However, both agents effectively treat high platelet reactivity. These results are in the same line of evidence with studies in mixed (diabetes and non-diabetes) patient populations,” Dimitrios Alexopoulos, MD, FACC, FESC, professor and chief of cardiology, Patras University Hospital, Greece, and colleagues wrote in Diabetes Care.
The prospective, single-center, single-blind, crossover study included 30 ACS patients with diabetes scheduled to undergo PCI. All received pretreatment with clopidogrel. Patients were randomly assigned 90 mg ticagrelor (Brilinta, AstraZeneca) twice daily or 10 mg prasugrel (Effient, Eli Lilly/Daiichi Sankyo) once daily for 15 days. Platelet reactivity was assessed with the VerifyNow P2Y12 assay and measured in P2Y12 reaction units (PRU).
Platelet reactivity was significantly lower after ticagrelor treatment compared with prasugrel treatment (45.2 PRU vs. 80.8 PRU; least squares mean difference, –35.6 PRU; P=.001).
The high platelet reactivity rate was 3.3% for prasugrel and 0% for ticagrelor (P=1).
There were no reports of major bleeds or major adverse CV events in either group.
"The relevance of these findings to the clinical efficacy and safety of ticagrelor and prasugrel in diabetes patients needs further elucidation,” the researchers concluded.
Disclosure: Alexopoulos reports receiving speaker fees from AstraZeneca. The other researchers report no relevant financial disclosures.