Study: New Anticlotting Drug Beats Warfarin
Eliquis More Effective at Preventing Strokes in Patients With Atrial Fibrillation
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Atrial Fibrillation and Stroke Risk continued...
This means that for every 1,000 patients treated for nearly two years, Eliquis, as compared with warfarin, prevented six strokes, 15 serious bleeding episodes, and eight deaths, says study head Christopher B. Granger, MD, of Duke University Medical Center in Durham, N.C.
The benefit in stroke prevention was driven mainly by the difference in bleeding (hemorrhagic) stroke, with Eliquis preventing four hemorrhagic strokes per 1,000 patients and two clot-related (ischemic) strokes per 1,000 patients.
Eliquis bested warfarin in all subgroups of patients studied, regardless of age, gender, weight, or prior use of warfarin, among other characteristics, Granger tells WebMD.
Pros and Cons of New Drugs
The new drugs -- Eliquis, Pradaxa and Xarelto -- are all wins for patients, says Michael Bonn, MD. Bonn is chairman of the committee that chooses which studies to highlight at the meeting. He is also a cardiologist at University Hospital of Saarland in Homburg, Germany.
Bonn says the new drugs provide the same or better protection as warfarin, but without the need for frequent blood monitoring or food interactions.
There aren't any studies directly comparing the newer drugs to each other. But Eliquis appears to have some advantages over Pradaxa, which is already FDA approved for stroke prevention in AF patients, and Xarelto, which is approved for prevention of potentially deadly blood clots in the legs of patients undergoing joint replacement surgery, he tells WebMD. An FDA advisory committee is meeting next month to consider Xarelto for stroke prevention in AF.
For example, Xarelto worked at least as well as warfarin at preventing strokes. But unlike Eliquis, it did not improve survival. And the major study upon which approval of Pradaxa was based showed that drug was associated with higher rates of heart attack and stomach bleeds than warfarin.
But Pradaxa is the only drug to lower the rate of ischemic stroke, the type of stroke caused by blood clots, compared with warfarin. And while the other drugs have to be taken twice daily, Xarelto only has to be taken once a day, increasing the chance patients will take their medication as prescribed, Brindis says.
Another new anticlotting drug, edoxaban, is being tested in a different study, called the ENGAGE study.
Brindis notes that all the newer agents have some potential downsides.
For starters, warfarin is available generically for $4 a month, while Pradaxa can cost $160 a month.
And while doctors can give vitamin K to quickly reverse the effects of warfarin in the case of dangerous bleeding, there's no quick antidote for bleeding caused by the newer agents, he says.
"That's not a trivial issue. The rate of major bleeds in patients on anticlotting drugs is 2% to 3% per year," Brindis says.