TRITON results and its implications

It is impressive to note that prasugrel has good antiplatelet activity with excellent clinical results. (TRITON, 2007)

• A 52 % reduction in stent thrombosis is very promising (2.4:1.1, in favor of prasugrel).

• An Overall reduction of death, MI, or stoke (MACE) by about 20%.

• Slightly increased incidence of bleeding (2.4:1.8, in favor of clopidogrel).

• No significant difference in all cause mortality (3.2 vs.3.0).

• However, a slightly higher risk of MACE noted in females, patients over 65 years, and non-diabetics who were treated with prasugrel.

• Diabetics did much better with prasugrel compared to clopidogrel, (MACE 17%:12.2% in favor of prasugrel).

Major questions:

• Is prasugrel going to have a major effect on the clinical use?

• Now, knowing the clinical efficacy and overall results, will the widespread clinical use depend on the drug cost?

• When clopidogrel patent expires and when the generics come in to the market, can prasugrel expect to charge higher prices?

• Is prasugrel ready to compete with the generics?

• Will the increased overall results be able to swing the physicians to prescribe a more expensive drug?

• Will the patients be ready to pay for a more expensive drug when a cheaper drug is available?

• Will the managed care companies accept,”Prescribe as written,” based on these study results or will they simply substitute for a cheaper generic?

• If managed care carriers simply substitute for a cheaper generic, where does prasugrel stand as a brand name drug and how it will grain market share?

• How will the company educate the physicians on the prasugrel overall efficacy and significant reduction in stent thrombosis?

• Is prasugrel arriving a little too late to have major influence?

Time will answer most of these questions!

Nik

Nik Nikam, M.D.