PEGASUS-TIMI 54 Subanalysis: Discontinuation of Ticagrelor Mostly Due to Dyspnea or Bleeding

Original Title: Long-term tolerability of ticagrelor for secondary prevention: insights from PEGASUS-TIMI 54 trial. Presenter: Bonaca MP.

The higher rate of premature discontinuation of ticagrelor vs placebo in the PEGASUS-TIMI 54 of stable outpatients with prior MI is attributed to more frequent dyspnea and bleeding, according to a new study.

Among patients who tolerated therapy for the first year, rates of discontinuation associated to adverse events were relatively low, roughly 3% per year in the following years.

Researchers analyzed discontinuations in the trial, which included 21,162 patients who had been stable 1 to 3 years after an MI. They all received low dose aspirin in addition to their assigned study drug or placebo. Overall, premature discontinuation at 3 years was higher with the 90-mg and 60-mg 2 per day dose of ticagrelor (32% and 29%, respectively) than with placebo (21%). Most interruptions were due to adverse events.

Much of the difference in discontinuations associated to adverse events was the result of higher rates of dyspnea and bleeding with ticagrelor. At 3 years, dyspnea rates were 6.5%, 4.6%, and 0.8% and bleeding rates were 7.8%, 6.2%, and 1.5% in the 90-mg twice a day ticagrelor dose, 60-mg twice a day ticagrelor and placebo groups, respectively.