title: Ticagrelor Versus Clopidogrel in Black Patients With Stable Coronary Artery Disease: Prospective, Randomized, Open-Label, Multiple-Dose, Crossover Pilot Study.
abstract: BACKGROUND
  The burden of coronary artery disease (CAD) is high in blacks, highlighting the need for clinical research of antiplatelet agents in this population. We sought to evaluate platelet reactivity during loading and maintenance dosing of ticagrelor versus clopidogrel, and the pharmacokinetic profile of ticagrelor and its metabolite AR-C124910XX, in black patients with stable CAD taking low-dose aspirin (acetylsalicylic acid).
  
  
  RESULTS
  In a multicenter, randomized, open-label, crossover study, 34 blacks with stable CAD receiving acetylsalicylic acid 75 to 100 mg/d were randomized to clopidogrel (600 mg, then 75 mg QD for 7-9 days) or ticagrelor (180 mg, then 90 mg BID for 7-9 days). After washout 10 to 14 days, patients switched regimens. The primary end point was platelet reactivity 2 hours post loading dose (P2Y12 reactivity units [PRU] measured by the VerifyNow assay). Least-squares mean PRU at 2 hours post loading dose was lower with ticagrelor (27.6) versus clopidogrel (211.2); least-squares mean difference was -183.6 (95% confidence interval, -213.9 to -153.3; P<0.001). At all time points, the least-squares mean PRU was significantly lower, and the percent reduction in PRU from baseline was statistically greater, with ticagrelor versus clopidogrel. At 2 hours post dose, the prevalence of high on-treatment platelet reactivity (≥208 PRU) was lower with ticagrelor (0%) than with clopidogrel (57.1%). Pharmacokinetic profiles of ticagrelor and AR-C124910XX were consistent with previous reports in stable CAD populations.
  
  
  CONCLUSIONS
  In black patients with stable CAD receiving low-dose acetylsalicylic acid, ticagrelor provided a faster onset and greater degree of platelet inhibition than clopidogrel.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01523392.
authors.affiliation: From the Section of Interventional Cardiology, MedStar Washington Hospital Center (R.W.); GFC, Global Medicines Development, AstraZeneca LP, Wilmington, DE (J.M., G.F.C., R.T., R.J.C.); Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL (D.J.A.); and Heart and Vascular Institute, Tulane University, New Orleans, LA (K.C.F.). ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.affiliation: From the Section of Interventional Cardiology, MedStar Washington Hospital Center (R.W.); GFC, Global Medicines Development, AstraZeneca LP, Wilmington, DE (J.M., G.F.C., R.T., R.J.C.); Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL (D.J.A.); and Heart and Vascular Institute, Tulane University, New Orleans, LA (K.C.F.).
authors.forename: Juan
authors.initials: J
authors.lastname: Maya
authors.affiliation: From the Section of Interventional Cardiology, MedStar Washington Hospital Center (R.W.); GFC, Global Medicines Development, AstraZeneca LP, Wilmington, DE (J.M., G.F.C., R.T., R.J.C.); Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL (D.J.A.); and Heart and Vascular Institute, Tulane University, New Orleans, LA (K.C.F.).
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.affiliation: From the Section of Interventional Cardiology, MedStar Washington Hospital Center (R.W.); GFC, Global Medicines Development, AstraZeneca LP, Wilmington, DE (J.M., G.F.C., R.T., R.J.C.); Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL (D.J.A.); and Heart and Vascular Institute, Tulane University, New Orleans, LA (K.C.F.).
authors.forename: Glenn F
authors.initials: GF
authors.lastname: Carlson
authors.affiliation: From the Section of Interventional Cardiology, MedStar Washington Hospital Center (R.W.); GFC, Global Medicines Development, AstraZeneca LP, Wilmington, DE (J.M., G.F.C., R.T., R.J.C.); Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL (D.J.A.); and Heart and Vascular Institute, Tulane University, New Orleans, LA (K.C.F.).
authors.forename: Renli
authors.initials: R
authors.lastname: Teng
authors.affiliation: From the Section of Interventional Cardiology, MedStar Washington Hospital Center (R.W.); GFC, Global Medicines Development, AstraZeneca LP, Wilmington, DE (J.M., G.F.C., R.T., R.J.C.); Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL (D.J.A.); and Heart and Vascular Institute, Tulane University, New Orleans, LA (K.C.F.).
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Caplan
authors.affiliation: From the Section of Interventional Cardiology, MedStar Washington Hospital Center (R.W.); GFC, Global Medicines Development, AstraZeneca LP, Wilmington, DE (J.M., G.F.C., R.T., R.J.C.); Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL (D.J.A.); and Heart and Vascular Institute, Tulane University, New Orleans, LA (K.C.F.).
authors.forename: Keith C
authors.initials: KC
authors.lastname: Ferdinand
mesh_terms: D000241:Adenosine / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D001792:Blood Platelets / Q000187:drug effects; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000503:physiopathology; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010979:Platelet Function Tests; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin
keywords: African Americans; clopidogrel; coronary artery disease; platelet function tests; ticagrelor