A Comparison of Antiplatelet Therapies in Asian Subjects With Acute Coronary Syndrome

Eli Lilly and Company720 enrolled

Overview

The study will compare the safety and efficacy of prasugrel, administered at different doses with clopidogrel in the treatment of Asian participants with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

720

Conditions

Acute Coronary Syndrome

Interventions

PrasugrelDRUG

Oral, daily, 90 days

ClopidogrelDRUG

Oral, daily, 90 days

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * A person who has been diagnosed with acute coronary syndrome (ACS) and is to undergo a percutaneous coronary intervention (PCI) * A person who is of East or Southeast Asian descent * A person who is of the legal age of 18 (or age 21 in Singapore) and is mentally competent to provide a signed written informed consent before entering the study * If a woman is of childbearing potential, she must test negative for pregnancy and agree to use a reliable method of birth control Exclusion Criteria: * A person who has a severe cardiovascular condition such as cardiogenic shock at the time of randomization, ventricular arrhythmias or congestive heart failure * A person who is at an increased risk of bleeding (e.g. active internal bleeding, history of bleeding disorder, recent fibrinolytic therapy before randomization into the study) * A person who has prior history of any one of the following: ischemic or hemorrhagic stroke; intracranial neoplasm, arteriovenous malformation, or aneurysm; prior history of transient ischemic attack (TIA) * A person who needs to take other antiplatelet therapy other than Aspirin for the duration of the study * A person who receives daily treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 (COX2) inhibitors that cannot be discontinued * A person who has a severe liver disease, such as cirrhosis * A person who has a condition such as alcoholism, mental illness, or drug dependence

Locations (19)

Outcomes

Primary Outcomes

Adenosine Diphosphate (ADP)-Induced P2Y12 Receptor-mediated Platelet Aggregation (P2Y12 Reaction Units; PRU) Using the Accumetrics VerifyNow (VN) P2Y12 Assay at 4 Hours Post-Loading Dose (LD) in Primary Cohort (≥60 kg and <75 Years)

ADP-induced PRU represents the rate and extent of ADP-stimulated platelet aggregation and serves as a biomarker of clinical efficacy, with lower values indicating greater P2Y12 platelet inhibition. Observed PRU values are presented with statistical comparisons of difference in least squares mean (LS mean) PRU values between prasugrel and clopidogrel. Efficacy analyses are analyzed and presented separately for the LD and maintenance dose (MD) phase.

Time frame: At 4 hours following LD administration

Adenosine Diphosphate (ADP)-Induced P2Y12 Reaction Units (PRU) Using the Accumetrics VerifyNow (VN) P2Y12 Assay at 30 Days During Maintenance Dose (MD) Administration in Primary Cohort

Efficacy analyses are analyzed and presented separately for the loading dose (LD) and MD phase. This primary outcome analysis compares PRU for the 3 prasugrel MDs (10 mg, 7.5 mg, and 5 mg) with the clopidogrel 75-mg MD at 30 days post-MD in the primary cohort (participants who weighed ≥60 kg and were \<75 years). ADP-induced PRU serves as a biomarker of clinical efficacy, with lower values indicating greater P2Y12 platelet inhibition. Observed PRU values are presented with statistical comparisons of LS mean difference between prasugrel and clopidogrel.

Time frame: At 30 days during MD therapy

Secondary Outcomes

Adenosine Diphosphate (ADP)-Induced P2Y12 Reaction Units (PRU) Using the Accumetrics VerifyNow (VN) P2Y12 Assay at 30 Minutes, 2 and 4 Hours Post-Loading Dose (LD) in Primary (≥60 kg and <75 Years) and Low Weight/Elderly (<60 kg or ≥75 Years) Cohorts.

Efficacy analyses analyzed and presented separately for LD and maintenance dose (MD) phase. Analysis compares PRU for prasugrel LDs (30 mg and 60 mg) with clopidogrel 300-mg LD at 30 minutes post-LD. Data for Primary Cohort at 4 hours post-LD, already presented in first Primary Outcome Measure, are also presented here. ADP-induced PRU serves as biomarker of clinical efficacy, with lower values indicating greater P2Y12 platelet inhibition. Observed PRU values presented with statistical comparisons of least-squares mean (LS mean) difference between prasugrel and clopidogrel.

Data from ClinicalTrials.gov

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Beijing, China

Guangzhou, China

Hangzhou, China

Nanjing, China

Shanghai, China

Shenyang, China

Wenzhou, China

Xi'an, China

Daegu, South Korea

Kwangju, South Korea

...and 9 more locations

Time frame: At 30 minutes, 2 hours, and 4 hours following LD administration

Adenosine Diphosphate (ADP)-Induced P2Y12 Reaction Units (PRU) Using the Accumetrics VerifyNow (VN) P2Y12 Assay at During Maintenance Dose (MD) Phase at 30 Days and 90 Days in Primary Cohort and Low Weight/Elderly Cohort

Efficacy analyses analyzed and presented separately for loading dose (LD) and MD phase. Analysis compares PRU for 3 prasugrel MDs (10 mg, 7.5 mg, and 5 mg) with clopidogrel 75-mg MD at 30 days post-MD. Data for Primary Cohort at 30 days post-LD, already presented in second Primary Outcome Measure, are also presented here. ADP-induced PRU serves as a biomarker of clinical efficacy, with lower values indicating greater P2Y12 platelet inhibition. Observed PRU values are presented with statistical comparisons of least squares (LS) mean difference between prasugrel and clopidogrel.

Time frame: At 30 Days and 90 days during MD therapy

Percent Inhibition of Adenosine Diphosphate (ADP)-Induced P2Y12 Reaction Units (PRU) at 30 Minutes, 2 Hours, and 4 Hours Post-Loading Dose (LD) in Primary in Primary Cohort and Low Weight/Elderly Cohort

A higher percentage (percent inhibition least squares mean \[LS mean\]) represents greater platelet inhibition.

Time frame: 30 minutes, 2 hours, and 4 hours following LD administration

Percent Inhibition of Adenosine Diphosphate (ADP)-Induced P2Y12 Reaction Units (PRU) During the Maintenance Dose (MD) Phase at 30 Days and 90 Days in Primary Cohort and Low Weight/Elderly Cohort

A higher percentage (percent inhibition least squares mean \[LS mean\]) represents greater platelet inhibition.

Time frame: 30 days and at 90 days during MD therapy

Summary of Myocardial Infarction (MI), Stroke, Stent Thrombosis and Urgent Target Vessel Revascularization (UTVR) in Primary Cohort and Low Weight/Elderly Cohort

Nonfatal MI: American College of Cardiology (ACC) definition Nonfatal stroke: rapid onset of new, persistent neurologic deficit lasting \>24 hours; classified as either ischemic or hemorrhagic based on imaging data, if available, or uncertain cause if imaging data was not available. Stent thrombosis: defined as definite, probable, or possible, based on Academic Research Consortium definitions. UTVR: percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) for recurrent ischemia. Revascularization must have included the vessel(s) dilated at the initial procedure

Time frame: Randomization through end of study (90 days)

Risk of Cardiovascular (CV) Death, Nonfatal Myocardial Infarction (MI), or Non-fatal Stroke

Risk was defined as the number of participants with events of CV death, nonfatal MI, or nonfatal stroke. CV death: death caused by CV event or not clearly attributable to non-CV causes. Nonfatal MI: per adapted American College of Cardiology definition. Nonfatal stroke: rapid onset of new, persistent neurologic deficit lasting more than 24 hours; either ischemic or hemorrhagic based on imaging data, if available, or uncertain cause if imaging data was not available. As a consequence of the overall low number of reported clinical events, composite endpoints were not analyzed.

Time frame: 30 days and 90 days

Risk of Cardiovascular (CV) Death, Nonfatal Myocardial Infarction (MI), or Urgent Target Vessel Revascularization (UTVR)

Risk was defined as the number of participants with events of CV death, nonfatal MI, or UTVR. UTVR: percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) for recurrent ischemia. Revascularization must have included the vessel(s) dilated at the initial procedure. As a consequence of the overall low number of reported clinical events, composite endpoints were not analyzed.

Time frame: 30 days and 90 days

Risk of Cardiovascular (CV) Death, Nonfatal Myocardial Infarction (MI), Nonfatal Stroke, or Recurrent Myocardial Ischemia Requiring Hospitalization

Risk was defined as the number of events of CV death, nonfatal MI, nonfatal stroke or recurrent myocardial ischemia requiring hospitalization. Recurrent myocardial ischemia requiring hospitalization: rehospitalization for symptoms of myocardial ischemia at rest with either new ST-segment deviation ≥1 mm, or performance of a coronary revascularization procedure percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) during the same hospital stay. As a consequence of the overall low number of reported clinical events, composite endpoints were not analyzed.

Time frame: 30 days and 90 days

Risk of Cardiovascular (CV) Death, Nonfatal Myocardial Infarction (MI), Nonfatal Stroke, Urgent Target Vessel Revascularization (UTVR), or Recurrent Myocardial Ischemia Requiring Hospitalization (Analyzed Individually)

Risk was defined as the number of participants with events of CV death, nonfatal MI, nonfatal stroke, UTVR, or recurrent myocardial ischemia requiring hospitalization.

Time frame: 30 days and 90 days

Risk of Definite or Probable Stent Thrombosis Per ARC (Academic Research Consortium) Definition

Risk was defined as the number of participants with events of definite or probable stent thrombosis. As a consequence of the overall low number of reported clinical events, composite endpoints were not analyzed.

Time frame: 30 days and 90 days

Risk of Definite, Probable, or Possible Stent Thrombosis Per Academic Research Consortium (ARC) Definition

Risk was defined as the number of participants with events of definite, probable, or possible stent thrombosis. As a consequence of the overall low number of reported clinical events, composite endpoints were not analyzed.

Time frame: 90 days

Risk of All-cause Death in Primary Cohort and Low Weight/Elderly Cohort

Risk was defined as the number of participants with events of all-cause death.

Time frame: Randomization through end of study (90 days)

Incidence of Non-coronary Artery Bypass Graft (CABG) Related Thrombolysis in Myocardial Infarction (TIMI) Life-threatening (a Subset of Non-CABG-related TIMI Major Bleeding), Major, Minor, and Minimal Bleeding

Bleeding events were classified and analyzed in accordance with the TIMI criteria definitions. Major bleeding: any intracranial hemorrhage (ICR) OR any clinically overt bleeding (including bleeding evident on imaging studies) associated with a fall in hemoglobin (Hgb) of ≥5 grams/deciliter (gm/dL) from baseline. Minor bleeding: any clinically overt bleeding associated with a fall in Hgb of ≥3 but \<5 gm/dL from baseline. Insignificant bleeding: any bleeding event that does not meet criteria for a Major or Minor bleed.

Time frame: Randomization through end of study (90 days)

Incidence of CABG-related TIMI Major or Minor Bleeding.

Time frame: Randomization through end of study (90 days)

Inpatient Healthcare Resource Utilization

Healthcare resource utilization data were modeled from historical analyses to determine initial hospitalization costs, total 30-day medical care costs, and total 90-day medical care costs.

Time frame: Initial hospitalization, 30 days, 90 days

Genetic Variation Related to Drug Metabolism and Transport Substudy Result Summary

The primary hypothesis for the genetics substudy was that CYP2C19 genetic variation has a significant effect on pharmacodynamic (PD) response to clopidogrel but not on PD response to prasugrel per change in PRU as measured by the Accumetrics VerifyNow P2Y12 device. Participants were classified by CYP2C19 genotype into predicted metabolic phenotypes according to literature-based functional predictions. These classifications were clustered into 2 groups: extensive metabolizer (EM) and reduced metabolizer (RM). A higher value for change in PRU indicates a greater level of platelet inhibition.

Time frame: Baseline to 4 hours post-loading dose (LD), 30 days and 90 days during maintenance dose (MD) phase

Risk of CV Death, Nonfatal MI, Nonfatal Stroke, UTVR, or Recurrent Myocardial Ischemia Requiring Hospitalization (Analyzed Individually)

Time frame: 30 days and 90 days