Ticagrelor No Better Than Clopidogrel in Patients with Symptomatic Peripheral Artery Disease

November 13, 2016

Ticagrelor No Better Than Clopidogrel in Patients with Symptomatic Peripheral Artery Disease

  1. Harlan M. Krumholz, MD, SM

Findings from the EUCLID trial do not support use of the higher-cost platelet inhibitor in this clinical context.

  1. Harlan M. Krumholz, MD, SM

Ticagrelor is a more expensive platelet inhibitor than clopidogrel, prompting ticagrelor's manufacturer to sponsor comparative-effectiveness studies. In the EUCLID trial, 13,885 people (median age, 66; 72% men) with symptomatic peripheral artery disease (PAD) were randomized, in double-blind fashion, to receive ticagrelor (90 mg twice daily) or clopidogrel (75 mg once daily). About three quarters of the participants were taking statins.

During a median follow-up of 30 months, incidence of the primary endpoint — cardiovascular death, myocardial infarction, or ischemic stroke — was statistically similar with ticagrelor and clopidogrel, both overall (10.8% and 10.6%, respectively) and in most prespecified subgroups. Secondary outcomes were also similar with the two drugs, as was the incidence of major bleeding. Discontinuation related to adverse effects was significantly more common with ticagrelor than clopidogrel.

Comment

This randomized trial provides no support for ticagrelor over clopidogrel in patients with symptomatic PAD. The findings also raise the broader question of whether ticagrelor should have any role in secondary prevention.

Editor Disclosures at Time of Publication

  • Disclosures for Harlan M. Krumholz, MD, SM at time of publication Consultant / Advisory board United Healthcare (Advisory Board); Element Science (Consultant) Equity ImageCor; Hugo PHR Grant / Research support Agency for Healthcare Research and Quality; Food and Drug Administration; National Heart, Lung, and Blood Institute; Robert Wood Johnson Foundation; Medtronic; Johnson & Johnson; Chinese National Center for Cardiovascular Disease; Centers for Medicare & Medicaid Services Editorial boards BMJ.com/US; American Journal of Managed Care; American Journal of Medicine; Archives of Medical Science; Critical Pathways in Cardiology; Current Cardiovascular Risk Reports; JACC: Cardiovascular Imaging; Circulation: Cardiovascular Quality and Outcomes; Circulation (Associate Editor)

Citation(s):

Reader Comments (2)

Rajeev Gupta,MD,DM Physician, Cardiology, Al Jowhara-mediclinic Hospital, Al Ain, UAE

Need to be astute before accepting the message.The clopidogrel group had only patients who were non-resistant (proven) to clopidogrel. With this design of the study, the chances to show superiority of ticagrelor will be limited. In many earlier studies with clopidogrel this was not done, therefore superirity of the comparator could be proven.

LAWRENCE COHN MD Physician, Psychiatry, OFFICE PINECREST, FL

NOT A SURPRISING RESULT AS LESSER POWERED STUDIES HAD SAME RESULT BUT USEFUL

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