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FDA Delays Decision on Blood Thinner Eliquis

One of Three Warfarin Alternatives for Stroke Prevention
By
WebMD Health News
Reviewed by Louise Chang, MD

bloodstream

June 25, 2012 -- The FDA has once again delayed a decision on a new blood thinning drug that some are calling a game changer for the prevention of stroke in heart patients.

Drug makers Bristol-Myers Squibb and Pfizer are seeking approval to market the drug Eliquis for use in patients with atrial fibrillation, a heart condition that affects about 3 million Americans and is projected to affect 12 million by 2050.

People with the heart rhythm disorder have about a five-fold increase in stroke risk.

In a trial sponsored by the companies, patients who took the drug twice a day were 21% less likely to suffer strokes than patients who took the blood thinner warfarin, which has been a standard treatment for the prevention of blood clots for many decades.

Eliquis users also had 31% fewer major bleeding episodes and their risk of death was reduced by 11%.

In a statement released today, the companies confirmed that the FDA is not asking for new studies of the drug, which could delay a decision for years.

Instead, federal officials want more information "on data management and verification" from the pivotal trial.

New-Generation Stroke Drugs

Eliquis is one of three new blood thinners developed as alternatives to warfarin.

Pradaxa, marketed by global drug maker Boehringer Ingelheim, became the first of the new-generation drugs to be approved late in 2010, followed last summer by Xarelto, marketed by Johnson & Johnson and Bayer AG.

Last November, the FDA granted an expedited review for Eliquis, which suggested that it would rule quickly on its approval. But in March the agency postponed action on the request until late June.

The arrival of the three new drugs has been widely anticipated, because the drugs are easier to take and believed to be safer that warfarin, which is also known as Coumadin.

Patients on warfarin must have their blood tested frequently because the drug can increase their risk for potentially life-threatening bleeding. It also interacts with some other drugs and foods, such as dark, leafy greens.

Safety Questions Remain

Although patients on the new drugs do not have to be monitored as closely as those taking warfarin, safety questions have plagued Pradaxa and Xarelto since they entered the U.S. market.

In the months after Pradaxa was approved for use in patients with atrial fibrillation, about 500 cases of hemorrhaging were reported, according to the nonprofit group Institute for Safe Medicine Practices.

Most of these cases occurred among elderly patients.

Just days ago, the FDA rejected an application to allow Xarelto to be used to treat patients with blocked coronary arteries.

Reversal Strategy Not Clear

Cardiologist Vincent Bufalino, MD, who practices in Elmhurst, Ill., says another safety concern has emerged since the new drugs became available.

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