Brilique is licensed for use in combination with aspirin to prevent atherothrombotic events in patients with acute coronary syndromes (ACS), including those managed medically, with percutaneous coronary intervention and with CABG.

PHARMACOLOGY

Ticagrelor is a selective adenosine diphosphate (ADP) receptor antagonist, which reversibly interacts with the platelet P2Y₁₂ ADP receptor to prevent ADP-mediated platelet activation and aggregation.¹

CLINICAL STUDIES

The efficacy of ticagrelor and clopidogrel was compared in a double-blind trial involving 18,624 patients hospitalised for ACS with or without ST-segment elevation, with symptom onset during the previous 24 hours; clopidogrel in combination with aspirin is currently the treatment of choice in this patient group.²

Patients were randomised to receive ticagrelor (loading dose of 180mg followed by 90mg twice daily) or clopidogrel (loading dose of 300-600mg followed by 75mg daily) in combination with aspirin (75-100mg daily) if tolerated.²

After 12 months, significantly fewer patients in the ticagrelor group reached the primary efficacy endpoint (death from vascular causes, MI or stroke) than in the clopidogrel group (9.8% versus 11.7%, p<0.001).²

The incidence of several of the major secondary endpoints was also significantly lower with ticagrelor than with clopidogrel: death from any cause, MI or stroke (10.2% versus 12.3%, p<0.001); death from vascular causes, MI, stroke, recurrent ischaemia [including severe], TIA or other arterial thrombotic event (14.6% versus 16.7%, p<0.001); MI (5.8% versus 6.9%, p=0.005); and death from vascular causes (4.0% versus 5.1%, p=0.001).

In addition, ticagrelor was associated with a reduction in the rate of death from any cause compared with clopidogrel (4.5% versus 5.9%, p<0.001).²

The incidence of stroke did not differ significantly between the two treatment groups (1.5% versus 1.3%, p=0.22) nor did the rate of major bleeding (primary safety endpoint; 11.6% versus 11.2%, p=0.43). However, the rate of bleeding not related to CABG was significantly higher for ticagrelor than for clopidogrel (4.5% versus 3.8%, p=0.03).²

Dyspnoea was also significantly more common in the ticagrelor group, occurring in 13.8% of patients compared with 7.8% of patients in the clopidogrel group (p<0.001).2

In addition, a greater incidence of ventricular pauses ≥3 seconds was observed in the ticagrelor group in week one but not at day 30, and this group also had a greater increase in creatinine and uric acid levels during the treatment period than the clopidogrel group.2 The other most commonly reported adverse effects for ticagrelor include contusion and epistaxis.¹

Similar results were observed in a secondary analysis involving a subset of patients with a planned early invasive strategy (n=13,408).3 In this subgroup, the rate of the primary efficacy endpoint was 9% in the ticagrelor group compared with 10.7% in the clopidogrel group (p=0.0025). In addition, the rate of all-cause mortality was significantly lower with ticagrelor than with clopidogrel (3.9% versus 5%, p=0.01) with no increase in the risk of major bleeding.³

Premature discontinuation of any antiplatelets, including ticagrelor, could result in an increased risk of cardiovascular death or MI as a result of the patient’s underlying disease and should therefore be avoided.¹ Any lapses in therapy should be avoided and a patient who misses a dose should take only one 90mg tablet at the next scheduled time.¹

^{FDA批准血液稀释药Brilinta用于治疗急性冠脉综合征
7月20日，美国食品和药物管理局（FDA）批准血液稀释药物BRILINTA（替卡格雷）用于减少急性冠脉综合征（ACS）患者的心血管死亡和心脏病发作。}

^{ACS包括引起一系列症状的多种疾病，如不稳定型心绞痛或心脏病发作，其可由于心脏血流量减少引发。Brilinta通过防止新的血液凝块的形成，从而保持血液在体内流动，帮助减少另外的心血管事件风险。}

^{已经对Brilinta与阿司匹林联合用药进行了研究。针对卫生保健专业人员和患者一个黑框警告警告说，阿司匹林剂量高于100mg/d可减少药物的有效性。}

^{FDA药物评价和研究中心心血管和肾脏产品部门主任Norman Stockbridge博士说道，在临床试验中，BRILINTA较氯吡格雷可更有效的预防心脏病发作和死亡，但这种获益只有司匹林的维持剂量为75-100mg/d时才可看到。}

^{黑框警告还说道，正如其他的血液稀释剂，Brilinta可增加出血发生率，并且可引起显著的，有时甚至是致命性的出血。在临床试验中服用BRILINTA的患者报告的最常见的不良反应是出血和呼吸困难（喘息）。}

^{BRILINTA被批准时要求进行风险评估和减灾战略，一种帮助确保药物的获益大于风险的计划。作为该计划的一部分，该公司必须对医生进行教育推广，提醒他们使用较高剂量阿司匹林的风险。此外，Brilinta还将有用药指南，告知患者最重要的用药信息。该指南将在每次开具处方时分发给每位患者。
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BRILINTA由威尔明顿阿斯利康生产}

Wilmington : AstraZeneca has announced that the US Food and Drug Administration (FDA) has approved BRILINTA (ticagrelor) tablets to reduce the rate of heart attack (myocardial infarction [MI]) and cardiovascular (CV) death in adult patients with acute coronary syndrome (ACS), compared to clopidogrel.

BRILINTA, a new oral antiplatelet medicine, is indicated to reduce the rate of thrombotic cardiovascular events in patients with ACS (unstable angina [UA] non-ST-elevation myocardial infarction [NSTEMI], or ST-elevation myocardial infarction [STEMI]). BRILINTA has been shown to reduce the rate of a combined endpoint of CV death, MI or stroke compared to clopidogrel.

The difference between treatments was driven by CV death and MI with no difference in stroke. In patients treated with an artery-opening procedure known as percutaneous coronary intervention (PCI), BRILINTA reduces the rate of stent thrombosis. BRILINTA has been studied in ACS in combination with aspirin. Maintenance doses of aspirin above 100 mg decreased the effectiveness of BRILINTA. Avoid maintenance doses of aspirin above 100 mg daily.

David Brennan, Chief Executive Officer, AstraZeneca said: “The FDA approval of BRILINTA is good news for patients in the United States and represents a significant milestone as we seek to help ensure ACS patients around the world have access to this innovative medicine. With over one million people affected by ACS in the US each year, the fact that physicians have a new and more effective treatment option than clopidogrel to help reduce the rate of heart attack and cardiovascular death in these patients is an important advance.”

Now that BRILINTA is approved in the US, AstraZeneca will begin the process of working with hospital formularies, protocol committees, government and managed care reimbursement bodies to bring this medicine to patients. Navigating these steps, which are necessary before BRILINTA will be available to a substantial number of incident ACS patients, will be a key focus for the next 12 months.

The FDA approval is based upon data from the landmark PLATO (A Study of PLATelet Inhibition and Patient Outcomes) study, a superiority trial that compared treatment with BRILINTA to clopidogrel in 18,624 ACS patients worldwide.

BRILINTA, like other antiplatelet agents, can cause significant, sometimes fatal, bleeding. In PLATO, there was no statistical difference in patients treated with BRILINTA compared to patients treated with clopidogrel in total major bleeding events (11.6% vs. 11.2%), including fatal and fatal/life-threatening bleeding events.2 Non-CABG (coronary artery bypass graft) major + minor bleeding events (8.7% vs. 7%) were more common with BRILINTA versus clopidogrel.

The most commonly observed adverse reactions associated with the use of BRILINTA vs. clopidogrel were bleeding (11.6% vs.11.2%) and a feeling of breathlessness called dyspnea (14% vs. 8%).

As with all AstraZeneca products, the company will work to ensure that physicians and patients understand both the benefits and risks associated with BRILINTA. For BRILINTA, one of the ways AstraZeneca will help ensure physicians and patients are appropriately informed about bleeding risk and the impact of aspirin dose on the effectiveness of BRILINTA is through a Risk Evaluation Mitigation Strategy (REMS).

According to the American Heart Association, over one million Americans are hospitalized with ACS every year. It is estimated that up to one in three patients could have a recurrent heart attack, or die within one year of their first CV event.¹

BRILINTA is now approved in 39 countries, including the US, Brazil, Australia, and Canada under the trade name BRILINTA and in the European Union under the trade name BRILIQUE™. BRILINTA is currently under regulatory review in an additional 45 countries, including Russia, India and China. BRILINTA is currently reimbursed in 7 countries.

PLATO was a large (18,624 patients in 43 countries) head-to-head patient outcomes study of ticagrelor versus clopidogrel, both given in combination with aspirin and other standard therapy, designed to establish whether ticagrelor could achieve a clinically meaningful reduction in cardiovascular end points in ACS patients, above and beyond those afforded by clopidogrel.

The study demonstrated that treatment with BRILINTA led to a greater reduction in the primary end point – a composite of CV death, MI, or stroke – compared to patients who received clopidogrel (9.8% vs. 11.7% at 12 months; 1.9% absolute risk reduction [ARR]; 16% relative risk reduction [RRR]; 95% CI, 0.77 to 0.92; P<0.001). The difference in treatments was driven by CV death and MI with no difference in stroke. In PLATO, the absolute difference in treatment benefit versus clopidogrel was seen at 30 days and the Kaplan-Meier survival curves continue to diverge throughout the 12 month treatment period.

The study also demonstrated that treatment with BRILINTA for 12 months was associated with a 21 percent RRR in CV death (4% vs. 5.1%; 1.1% ARR; P=0.001) and a 16 percent RRR in MI compared to clopidogrel at 12 months (5.8% vs. 6.9%; 1.1% ARR; P<0.005).

In a post hoc analysis of PLATO, it was determined that more than 80 percent of patients worldwide, including more than 40 percent of patients in the US, received low maintenance doses of aspirin (100 mg or less). Results for US and non-US patients taking BRILINTA with these low maintenance doses of aspirin were similar. Maintenance doses of aspirin above 100 mg reduced the effectiveness of BRILINTA, and should be avoided. After any initial dose, BRILINTA should be used with maintenance aspirin doses of 75-100 mg per day. As with any unplanned subset analysis, the post hoc analysis should be treated with caution.

阿斯利康公布了一项BRILINTA（替格瑞洛）三期优效性试验结果。

在PLATO（血小板抑制和患者结果研究）研究中，BRILINTA（替格瑞洛）在主要终点即心血管事件（心血管死亡，心肌梗死和卒中）减少方面都较PLAVIX（氯吡格雷）表现出了更大疗效，同时没有引起严重出血事件的增加。 BRILINTA是第一种在所有急性冠脉综合征患者（ACS）中证实减少心血管死亡的抗血小板药物。

目前，BRILINTA正在被开发用于急性冠脉综合征（ACS）患者的治疗。 ACS一词可用于描述进展期的心脏病发作或心脏病发作的紧急威胁状态。 ACS通常是由动脉中的血凝块形成部分或完全阻断一部分心肌的血液供应所致。

关于BRILINTA TM

替格瑞洛 (BRILINTA TM ) 是个研究为于急性冠脉综合征的口服抗小血板治疗 , 是首个口服的可逆性二磷酸腺苷（ADP ）受体拮抗剂。该药物可选择性抑制二磷酸腺苷的关键靶受体P2Y12 。ADP 受体阻滞则抑制血液中血小板的作用，从而减少复发性血栓事件的发生。

阿斯利康已经申请使用 BRILINTA 作为药名。如经美国食品药品监督管理局（ FDA ）和欧盟药品管理局（ EMEA ）的批准，则 BRILINTA 将作为替格瑞洛的商品名。 BRILINTA 是阿斯利康集团公司的一个商标。