This article is more than 5 years old. Information may no longer be current.
Switch from ticagrelor to prasugrel increased platelet reactivity
Click Here to Manage Email Alerts
Compared with patients who continued ticagrelor therapy, those who switched their P2Y12 inhibitor from ticagrelor to prasugrel had an increase in platelet reactivity that was partly mitigated by the administration of a loading dose.
In the SWAP-2 study, Dominick J. Angiolillo, MD, PhD, with the University of Florida College of Medicine, Jacksonville, and fellow researchers sought to evaluate the pharmacodynamic effects of switching patients from ticagrelor (Brilinta, AstraZeneca) to prasugrel (Effient, Daiichi Sankyo/Eli Lilly). After a 3- to 5-day run-in phase with a 180-mg ticagrelor loading dose followed by a 90-mg ticagrelor twice-daily maintenance dose, Angiolillo and colleagues randomly assigned aspirin-treated patients (n=110) with stable CAD to either continue ticagrelor or switch to prasugrel 10-mg once-daily maintenance dose, with or without a 60-mg loading dose.
Researchers made their pharmacodynamic assessments based on P2Y12 reaction unit (PRU) and platelet reactivity index at baseline (before and after the run-in phase) and 2, 4, 24 and 48 hours, and 7 days after randomization.Twenty-four and 48 hours after switching to prasugrel, platelet reactivity was significantly greater for those who switched than in those who continued ticagrelor therapy; however, the extent of the difference was less in those receiving a loading dose.
Dominick J. Angiolillo
In addition, mean PRU was significantly higher in the combined prasugrel arms than in the ticagrelor arm (upper limit of the confidence interval, ≤45), although it was lower in the prasugrel cohort at 7 days than at 24 or 48 hours. Researchers also found that at 24 and 48 hours, rates of high on-treatment platelet reactivity were higher in both prasugrel groups vs. the ticagrelor group.
There was no difference between the groups in terms of high on-treatment platelet reactivity rate at 7 days.
“SWAP-2 did not achieve the primary objective of noninferiority of pharmacodynamic response after switching from ticagrelor to prasugrel,” Angiolillo and colleagues wrote. “The results suggest a pharmacodynamics interaction when switching from ticagrelor to prasugrel, which is partially mitigated with administration of [a loading dose] of prasugrel. This interaction resulted in higher rates of [high platelet reactivity] in the first 24 to 48 [hours] after switching, which diminished by 7 days of treatment. The clinical implications of our study findings cannot be extrapolated from the results of this study and deserve further investigation as to the optimal timing of switching from ticagrelor to prasugrel.”
Click Here to Manage Email Alerts