TRITON results and its implications
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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.
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
