SOCRATES: Ticagrelor flops in stroke prevention study

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Ticagrelor (Brilinta, AstraZeneca) isn’t better secondary prevention for stroke patients than is aspirin, according to top-line results from the SOCRATES trial. This means that a 40-cent tablet, first sold by Bayer in 1899, was just as good at helping patients as AZ’s new drug that costs around $7 (before discounts) per daily treatment. The SOCRATES trial is part of PARTHENON, the largest ever AstraZeneca CV outcomes programme, involving nearly 80,000 patients at high risk of CV events (MI, stroke and/or CV death) due to their underlying disease.

AstraZeneca announced in March the top-line results of the SOCRATES trial, assessing the efficacy of Brilinta/Brilique (ticagrelor) 90mg tablets twice daily, when compared to aspirin 100mg once daily in patients with acute ischaemic stroke or transient ischaemic attack (TIA). The primary efficacy endpoint of time to first occurrence of any event from the composite of stroke (ischaemic or haemorrhagic), myocardial infarction (MI, also known as heart attack) and death was not met. Fewer events were observed on Brilinta/Brilique versus the comparator in the overall trial population but the trend did not reach statistical significance. Based on preliminary analyses, safety data is consistent with the known safety profile of Brilinta/Brilique. Sean Bohen, Executive Vice President, Global Medicines Development and Chief Medical Officer at AstraZeneca, said: “We will present the full analysis of the trial results, including subgroups, at a forthcoming stroke congress and will engage with regulatory agencies on the interpretation of the data.

The SOCRATES trial enrolled a patient population that differs from the currently-approved indications for Brilinta/Brilique.” The SOCRATES trial evaluated the efficacy and safety of 90-day treatment with Brilinta/Brilique versus aspirin for the prevention of major vascular events in patients > 40 years of age with an acute ischaemic stroke (National Institutes of Health Stroke Scale (NIHSS) < 5) or TIA (ABCD2 score ≥4). Patients randomised into the trial needed to have symptom onset within 24 hours. In the second half of 2016, data are expected from the ongoing EUCLID trial in peripheral arterial disease (PAD). EUCLID is the fourth trial to read-out from the PARTHENON programme, assessing the potential of Brilinta/Brilique in additional high-risk patient populations.

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