Diabetic patients are increased risk of thrombotic events, which is why an effective antiplatelet therapy is crucial for these patients. Both prasugrel and ticagrelor have shown to reduce thrombotic complications further than clopidogrel.
Subgroup analyzes of the most important studies testing prasugrel and ticagrelor vs. clopidogrel have shown that diabetic patients receiving the new antiplatelets obtained benefits consistent with those obtained on the general population, even though reduction seems to be more significant with prasugrel.
This study was designed to assess whether these differences could be explained by the pharmacodynamic profile of these drugs.
This was a prospective, randomized, double blind trial including 50 diabetic patients with heart disease undergoing treatment with aspirin, randomized to prasugrel (60 mg. loading dose (LD), maintenance dose 10 mg. once daily) vs. ticagrelor (180 mg LD. 90 mg. every12 hours).
Pharmacodynamics were assessed with four different assays including VerifyNow P2Y12.
The study measured the acute effect (baseline, 30 minutes and two hours post-LD) and maintenance, 1 week.
Primary end point was platelet reactivity between prasugrel and ticagrelor measured by VerifyNow.
Both at 30 minutes and 2 hours post LD, VerifyNow reaction units were similar between both drugs.
At one week, however, platelet reactivity was significantly lower with ticagrelor, compared to prasugrel (52 [32–72] vs. 83 [63–103]; p=0.022). Measurements by other methods did not show differences between the drugs, even after 1 week.
Rates of high on-treatment platelet reactivity were similar between groups with all assays at all time points.
Conclusion
In diabetic patients with heart disease, ticagrelor has a similar or even more potent effect than prasugrel.
Original Title: Pharmacodynamic Comparison of Prasugrel versus Ticagrelor in Patients with Type 2 Diabetes Mellitus and Coronary Artery Disease. The OPTIMUS (Optimizing Antiplatelet Therapy in Diabetes Mellitus)-4 Study.
Reference: Francesco Franchi et al. Circulation. 2016 Sep 13;134(11):780-92.
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