Delhi: Meta-analysis of Ticagrelor vs Prasugrel

A meta-analysis by Fong L.C.W. and team revealed that ticagrelor did not reduce the primary composite endpoint of myocardial infection (MI), stroke, and cardiovascular death compared to prasugrel at a weighted mean follow-up of 11 months. There was no significant difference between the secondary outcomes except MI. The findings of the study were published in Cardiology, the journal of the Karger publication.

Data on the direct comparison of prasugrel and ticagrelor for the management of ACS have been inconsistent. To ascertain the same, Fong L.C.W and the team conducted a meta-analysis to summarise the currently available evidence on the topic.

The researchers performed a meta-analysis (PROSPERO) of randomized trials up to Feb 2020 that compared prasugrel and ticagrelor in acute coronary syndrome with respect to the composite endpoint of MI, stroke or cardiovascular death, and secondary endpoints including MI, stroke, cardiovascular death, major bleeding (Bleeding Academic Research Consortium (BARC) type 2 or above), stent thrombosis, all-cause death, and other safety outcomes.

Of the 11 eligible Randomized Control Trials with 6098 patients randomized to prasugrel (n=3050) or ticagrelor (n=3048).

Results of the Study

• 180 and 207 had the composite endpoint events in the prasugrel arm and the ticagrelor arm respectively over a weighted mean follow-up period of 11±2 months.
• Compared with prasugrel, the ticagrelor group had a similar risk in the primary composite endpoint (Risk Ratio (RR)= 1.17).
• Compared to prasugrel, there was no significant difference associated with the use of ticagrelor groups with respect to stroke (RR=1.05); cardiovascular death (RR=1.01).
• BARC type 2 or above bleeding (RR=1.16); stent thrombosis (RR=1.58); all-cause death (RR=1.10) except MI (RR=1.38).

The authors concluded that "Compared with prasugrel, ticagrelor did not reduce the primary composite endpoint of MI, stroke and cardiovascular death at a weighted mean follow up of 11 months. There was no significant difference between the secondary outcomes except myocardial infarction."

Reference

Fong L, C, W, Lee N, H, C, Yan A, T, Ng M, -Y: Comparison of Prasugrel and Ticagrelor for Patients with Acute Coronary Syndrome: A Systematic Review and Meta-analysis. Cardiology 2021. doi: 10.1159/000520673