Prasugrel is Superior or Equivalent to Ticagrelor in ACS Patients undergoing PCI: A Systematic Review and Meta-Analysis

16 Feb, 18

Background

The newer generation oral P2Y12 receptor antagonists namely; prasugrel and ticagrelor are preferred over clopidogrel in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Nevertheless, the existing data comparing efficacy and safety of prasugrel and. ticagrelor is conflicting.

Aim

To compare the safety and efficacy of prasugrel vs. ticagrelor in ACS patients undergoing PCI

Patient Profile

Adult patients (age ≥18 years) with ACS and undergoing PCI

Methods

Study Design

A systematic review and meta-analysis

Study Selection

Randomized and non-randomized trials comparing prasugrel vs. ticagrelor and which reported at least one of the specified major outcome of interest as crude events

Major Outcomes

Mortality, myocardial infarction (MI), stroke, repeat revascularization, stent thrombosis (ST) and the Bleeding Academic Research Consortium (BARC) bleeding ≥2

Results

The meta-analysis included 9 studies that provided the data of 21360 patients (15666 treated with prasugrel and 5694 treated with ticagrelor)
The follow-up duration for the included studies ranged from 7 days to 12 months, but only 30-day outcomes were considered to reduce the heterogeneity
Prasugrel was associated with 46% lower rate of MI vs. ticagrelor [P = 0.05] (Table 1).
Prasugrel also showed a trend towards lower risk of stent thrombosis (ST) as compared to ticagrelor (Table 1)
Prasugrel and ticagrelor were similar in terms of incidence of mortality, repeat revascularization and stroke (Table 1)
Prasugrel was in fact, associated with a significant 25% lower risk of BARC ≥2 bleeding at 30 days vs. ticagrelor[

Table 1: Comparison of 30-day outcomes with the two study drugs

Outcome	Prasugrel	Ticagrelor	OR	P value
MI risk	0.8%	1.9%	0.54	0.05
Mortality	2.1%	2.4%	0.84	0.19
Repeat revascularization	1.6%	2.1%	0.82	0.19
Stroke	0.2%	0.3%	0.68	0.44
BARC ≥2	2.5%	3.8%	0.75	0.02
ST	0.3%	0.6%	0.55	0.08

Conclusions

Prasugrel was associated with a significantly lower risk of MI and lower risk of BARC ≥2 as compared to ticagrelor in ACS patients undergoing PCI
The risk of mortality, stroke, revascularization, and ST was similar with both the drugs
Thus, prasugrel seemed to be equivalent or superior to ticagrelor in ACS patients undergoing PCI.

Int J Cardiol. 2017; 249: 66-72