New P2Y12 Inhibitors

Description Results NMA

target vessel revascularization 0.72 [0.40; 1.30]

stroke 1.15 [0.39; 3.43]

MI 0.91 [0.75; 1.11]

death, MI, stroke, or target vessel revascularization 0.87 [0.72; 1.05]

target vessel revascularization 0.56 [0.28; 1.11]

All cause death 1.59 [0.52; 4.86]

MACE 0.67 [0.40; 1.14]

stroke 0.85 [0.29; 2.53]

MI 0.40 [0.12; 1.27]

death, MI, stroke, or target vessel revascularization 1.04 [0.89; 1.22]

cangrelor up front (cangrelor during PCI followed by 600 mg of clopidogrel) (n=2693)

vs.

delayed clopidogrel (placebo during PCI followed by 600 mg of clopidogrel) (n=2669)

cangrelor up front vs delayed clopidogrel

Patients with stable angina were initially eligible at the beginning of the trial before a protocol amendment

double blind

Parallel groups

Sample size: 2693/2669

Primary endpoint: death, MI, ischemia-driven revascularization

FU duration: 48 h

cangrelor up front (cangrelor administered before percutaneous coronary intervention and followed by clopidogrel) (n=4367)

vs.

clopidogrel up front (clopidogrel followed by placebo) (n=4355)

cangrelor then clopidogrel vs clopidogrel then placebo

double blind

Parallel groups

Sample size: 4367/4355

Primary endpoint: death, MI, ischemia-driven revascularization

FU duration: 48 h

major bleeding NaN [NaN; NaN]

non fatla stroke ∞ [NaN; ∞]

non fatal MI NaN [NaN; NaN]

elinogrel 10, 20, 40, or 60 mg as a single intravenous bolus (n=34)

vs.

placebo (n=36)

5 arms: 4 doses of elinogrel or placebo before the start of the diagnostic angiogram preceding primary PCI

double blind

Parallel groups

Sample size: 34/36

Primary endpoint: TIMI and ST resolution

FU duration: 30-37 days

phase IIb (dose-escalation study)

cardiovascular death, MI, stroke 0.78 [0.47; 1.31]

All cause death ∞ [NaN; ∞]

Non–CABG-related TIMI major bleeding 0.59 [0.10; 3.49]

Major or minor TIMI bleeding 1.43 [0.40; 5.09]

Vasc events 0.82 [0.74; 0.91]

revascularization 0.67 [0.55; 0.82]

Non-fatal MI 0.76 [0.68; 0.86]

all bleeding (major and minor) 1.31 [1.11; 1.55]

Major bleeds 1.31 [1.03; 1.68]

fatal bleeding 4.19 [1.58; 11.10]

all cause death 0.95 [0.78; 1.16]

Vasc deaths 0.88 [0.70; 1.11]

Non-fatal stroke 1.01 [0.71; 1.45]

Prasugrel 3 doses (n=650)

vs.

clopidogrel 300mg loading dose followed by 75 mg daily) (n=254)

double blind

Parallel groups

Sample size: 650/254

Primary endpoint: non–CABG-related bleeding

FU duration: 30 days

phase 2

prasugrel 60-mg loading dose and 10-mg daily maintenance dose, for 6 to 15 months (n=6813)

vs.

clopidogrel (a 300-mg loading dose and a 75-mg daily maintenance dose) for 6 to 15 months (n=6795)

double blind

Parallel groups

Sample size: 6813/6795

Primary endpoint: cardiovascular death, nonfatal MI, or nonfatal

FU duration:

vascular death, MI, stroke 0.85 [0.78; 0.92]

Vasc events 0.88 [0.82; 0.95]

all cause death 0.78 [0.69; 0.89]

Vasc deaths 0.80 [0.69; 0.91]

fatal and non fatal MI 0.85 [0.75; 0.95]

cardiovascular events 0.85 [0.78; 0.92]

death, MI, stroke 0.84 [0.77; 0.92]

Severe recurrent ischemia 0.87 [0.75; 1.01]

Hemorrhagic stoke 1.76 [0.89; 3.47]

all bleeding (major and minor) 1.04 [0.95; 1.13]

Major bleeds 1.03 [0.92; 1.14]

Ischemic stroke 1.05 [0.79; 1.40]

Non vasc deaths 0.72 [0.49; 1.04]

fatala and non fatal stroke 1.17 [0.91; 1.52]

fatal bleeding 0.87 [0.48; 1.58]

Vasc events 1.09 [0.58; 2.07]

all cause death 1.37 [0.44; 4.27]

all bleeding (major and minor) 1.11 [0.70; 1.77]

Major bleeds 0.98 [0.58; 1.65]

Vasc deaths 1.47 [0.42; 5.16]

fatala and non fatal stroke 1.96 [0.18; 21.49]

fatal and non fatal MI 0.78 [0.37; 1.65]

cardiovascular events 1.09 [0.58; 2.07]

ticagrelor 90mg twice daily (n=9333)

vs.

clopidogrel 75mg once daily (n=9291)

Patients undergoing PCI after randomization received, in a blind fashion, an additional dose of their study drug at the time of PCI

double blind

Parallel groups

Sample size: 9333/9291

Primary endpoint: Cv death, MI, stroke

FU duration: 1 y

ticagrelor 90 mg twice daily (n=334)

vs.

clopidogrel (n=327)

3 arms trial: AZD6140 90 mg and 180mg twice daily, Clopidogrel 75 mg daily

double blind

Parallel groups

Sample size: 334/327

Primary endpoint: major or minor bleeding through 4 weeks

FU duration: 12 weeks