Robert Storey, Professor of Cardiology at the University of Sheffield’s Department of Cardiovascular Science, has led UK investigations into the novel drug for the past 15 years. He said: “The approval by NICE is excellent news as this now provides a path for the introduction of ticagrelor across England and Wales. Many hospitals have not yet introduced ticagrelor because of concerns about higher cost compared to clopidogrel so the verdict from NICE that ticagrelor is a cost-effective use of NHS resources is an important milestone in the evolution of more effective treatments for heart attacks and will help to save many lives.”
The new guidance from NICE has recognised the drug´s ability to save lives when compared to the standard treatment, clopidogrel. This follows hot on the heels of the release of guidelines from the European Society of Cardiology which recommended ticagrelor as a first-line treatment for heart attack patients as well as higher risk patients with ‘unstable angina’. Professor Storey presented these new guidelines on the use of ticagrelor and other anticlotting drugs at the European Society of Cardiology annual conference in Paris.
Professor Storey has led UK investigations of ticagrelor and his findings have confirmed that one in five deaths in the year following a heart attack could be prevented if a new drug, ticagrelor, was used instead of the standard treatment, clopidogrel.
He was a member of the international committee that conducted the PLATO study, a trial of over 18 thousand patients in over 40 countries around the world. The results of the PLATO study were first presented at the European Society of Cardiology congress in 2009, showing that ticagrelor was more effective for heart attack patients than clopidogrel in reducing death and recurrent heart attack.
A new analysis of the PLATO study presented this year at the American College of Cardiology showed that ticagrelor is just as effective at reducing deaths in patients over the age of 75 as in younger patients.
Ticagrelor was made available in the UK in December 2010 but has not yet been adopted across most of the UK due to cost concerns. Clopidogrel has a very low cost as it is available in generic forms, whereas ticagrelor is more expensive at around £55 per month. However, the excess drug cost of ticagrelor is offset to some extent by its greater effectiveness which reduces the need for heart operations.
One of the problems with clopidogrel is that about a quarter of people in the UK have a genetic variant that reduces the effect of the drug and are at greater risk. A sub-study of the PLATO trial was published in the Lancet confirming that patients treated with clopidogrel, who have such a genetic variant, have a slightly higher risk in the first month following heart attack but ticagrelor is not affected by this variant and is still more effective than clopidogrel, regardless of a patient’s genetic make-up.
A common side-effect of ticagrelor is a sense of breathlessness which is usually mild and well-tolerated. Professor Storey presented data at the European Society of Cardiology meeting in 2010 showing that even patients who develop this side-effect still seem to have the reduced mortality risk compared to clopidogrel-treated patients. Another analysis led by Professor Storey showed that patients who develop breathlessness on ticagrelor do not show any problems on heart or lung tests, providing reassurance about the benign nature of ticagrelor-related breathlessness.
Notes for Editors: Ticagrelor is manufactured by pharmaceutical company AstraZeneca in Leicestershire. It is licensed by the European Medicines Agency for use, in combination with aspirin, in patients with acute coronary syndromes.
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