title: "Real-World" Comparison of Prasugrel With Ticagrelor in Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention in the United States.
abstract: OBJECTIVE
  The 30-day clinical outcomes with prasugrel or ticagrelor were compared using a US payer database in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Prasugrel and ticagrelor demonstrated superior efficacy with increased non-coronary artery bypass graft major bleeding compared with clopidogrel in randomized clinical trials. No direct randomized or observational studies have compared clinical outcomes between prasugrel and ticagrelor.
  
  
  METHODS
  Patients hospitalized for ACS-PCI between August 1, 2011 and April 30, 2013 and prescribed prasugrel or ticagrelor were selected. Drug treatment cohorts were propensity matched based upon demographic and clinical characteristics. The primary objective compared 30-day net adverse clinical events (NACE) in prasugrel- and ticagrelor-treated patients using a prespecified 20% noninferiority margin. Secondary objectives included comparisons of major adverse cardiovascular events (MACE) and major bleeding.
  
  
  RESULTS
  Data were available for 16,098 patients (prasugrel, n = 13,134; ticagrelor, n = 2,964). In unmatched cohorts, prasugrel-treated patients were younger with fewer comorbidities than ticagrelor-treated patients, and 30-day NACE rates were 5.6 and 9.3%, respectively (P < 0.001). Following propensity matching, NACE was noninferior (P < 0.001) and 22% lower in prasugrel-treated than in ticagrelor-treated patients (RR, 0.78; 95% CI, 0.64-0.94). A 30-day adjusted MACE (RR, 0.80; 95% CI, 0.64-0.98) and major bleeding (RR, 0.65; 95% CI, 0.45-0.95) were also lower in prasugrel-treated patients compared with ticagrelor-treated patients.
  
  
  CONCLUSIONS
  In this "real-world," retrospective, observational study, physicians appear to preferentially use prasugrel in younger patients with lower risk of bleeding or comorbidities compared with ticagrelor. Following adjustment, clinical outcomes associated with prasugrel use appear as good, if not better, than those associated with ticagrelor in ACS-PCI patients. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Eli Lilly and Company, US Medical Affairs, Indianapolis, Indiana. larmore_cynthia_jean@lilly.com.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Larmore
authors.affiliation: Eli Lilly and Company, US Medical Affairs, Indianapolis, Indiana.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Effron
authors.affiliation: Eli Lilly and Company, US Medical Affairs, Indianapolis, Indiana.
authors.forename: Cliff
authors.initials: C
authors.lastname: Molife
authors.affiliation: IMS Health, Health Economics and Outcomes Research/Real World Evidence Solutions, Plymouth Meeting, PA.
authors.forename: Mitch
authors.initials: M
authors.lastname: DeKoven
authors.affiliation: Eli Lilly and Company, US Medical Affairs, Indianapolis, Indiana.
authors.forename: Yajun
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: IMS Health, Health Economics and Outcomes Research/Real World Evidence Solutions, Plymouth Meeting, PA.
authors.forename: Jingsong
authors.initials: J
authors.lastname: Lu
authors.affiliation: IMS Health, Health Economics and Outcomes Research/Real World Evidence Solutions, Plymouth Meeting, PA.
authors.forename: Swapna
authors.initials: S
authors.lastname: Karkare
authors.affiliation: Eli Lilly and Company, US Medical Affairs, Indianapolis, Indiana.
authors.forename: Hsiao D
authors.initials: HD
authors.lastname: Lieu
authors.affiliation: IMS Health, Health Economics and Outcomes Research/Real World Evidence Solutions, Plymouth Meeting, PA.
authors.forename: Won Chan
authors.initials: WC
authors.lastname: Lee
authors.affiliation: VCU Pauley Heart Center, Richmond, Virginia.
authors.forename: George W
authors.initials: GW
authors.lastname: Vetrovec
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000628:therapy*; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000639:trends; D000068799:Prasugrel Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use*; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D000077486:Ticagrelor; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine
keywords: antiplatelet; major bleeding; myocardial infarction; observational study