Brilinta (ticagrelor; AstraZeneca/The Medicines Company) is an antiplatelet agent designed to inhibit blood clot formation. It works by reversibly binding to the blood platelets’ adenosine diphosphate (ADP) P2Y12 receptor. This prevents ADP-mediated activation of the glycoprotein IIb/IIIa complex (GPIIb/IIIa), which is necessary for platelet aggregation to occur.
Brilinta’s (ticagrelor; AstraZeneca/The Medicines Company) label expansion for the prolonged treatment of post-myocardial infarction (MI) patients will increase its commercial potential and eligible patient population within acute coronary syndrome (ACS). Positive data from the PEGASUS-TIMI 54 trial also provides AstraZeneca with the opportunity to rebuild the drug’s reputation, which was impacted by a Department of Justice (DoJ) investigation into its PLATO trial in the US. While twice-daily dosing and a contraindication with high-dose aspirin have dampened early uptake, Brilinta’s wide indication gives it a significant advantage over rival Effient (prasugrel; Eli Lilly/Daiichi Sankyo), which is only approved for use in patients who have undergone or will be undergoing invasive treatment. Furthermore, 2016 US treatment guidelines recommend Brilinta over its main competitor, Plavix (clopidogrel; Sanofi/Bristol-Myers Squibb), for the management of ACS patients who have received a coronary stent, and in non-ST elevation ACS patients treated with medical therapy alone. These recommendations further enhance Brilinta’s competitive potential within ACS.
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