An oral antiplatelet agent, Effient is a pro-drug which is converted to its active metabolite after
metabolism by cytochrome P450 enzymes. The active metabolite binds irreversibly to P2Y12 adenosine
diphosphate receptors on the surface of platelets. This inhibits their function and contributes to a
reduction in thrombus formation (Effient Prescribing Information, 2015).
Effient (prasugrel; Eli Lilly/Daiichi Sankyo) has struggled to capture patient share from its main
competitor, Plavix (clopidogrel; Sanofi/Bristol-Myers Squibb). While Effient has demonstrated clear
clinical benefits over Plavix, uptake has been hindered by its black box warning for increased risk of
bleeding. Effient’s failure to demonstrate superiority over Plavix in acute coronary syndrome (ACS)
patients managed without revascularization has restricted its use to patients treated with primary or
delayed percutaneous coronary intervention (PCI) only. The drug’s future commercial potential within
ACS is likely to be further limited by its expected loss of patent protection in 2017. Upon the launch
of generic prasugrel, Effient brand sales are likely to be rapidly eroded in a similar manner to Plavix.
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