Ticagrelor 60 mg and 90 mg twice daily yielded comparable platelet inhibition in both male and female elderly patients with acute coronary syndrome (p for interaction=0.88).
Does ticagrelor 60 mg twice daily provide similar platelet inhibition compared to ticagrelor 90 mg twice daily in elderly patients with acute coronary syndrome undergoing percutaneous coronary intervention, irrespective of sex?
Ticagrelor 60 mg twice daily provides similar platelet inhibition to the standard 90 mg dose in elderly ACS patients undergoing PCI, regardless of sex, despite yielding lower plasma levels.
Absolute Event Rate: 0% vs 0%
Abstract Background No sex-based data are available on the pharmacodynamic and pharmacokinetic profile of ticagrelor 60 mg twice daily as alternative to its standard dose during the early phase after acute coronary syndrome (ACS). Methods This post-hoc study is a sex-based secondary analysis of the PLINY THE ELDER randomized, crossover trial (NCT04739384), which compared ticagrelor 60 vs. 90 mg in elderly patients with ACS undergoing percutaneous coronary intervention (PCI). The primary endpoint was the pre-dose P2Y12 reaction units (PRU) using the VerifyNow-P2Y12 (Accumetrics, San Diego, CA, USA) at 14 days after treatment with ticagrelor 60 or 90 mg twice daily. Results A total of 50 elderly patients with ACS was included in the study. Of these patients, 28 (56%) were males and 22 (44%) females. The two doses of ticagrelor had a comparable pre-dose PRU in both males (pre-dose: LSM difference60 vs. 90 -7.00, 95%CI -25.3 to 11.3, p =0.44) and females (pre-dose: LSM difference60 vs. 90 -0.89, 95%CI -20.3 to 18.5, p =0.93), with no evidence of sex-based interaction (pre-dose: p for interaction =0.88). Consistently, transmittance aggregometry and multiple electrode aggregometry showed a similar pharmacodynamic profile between the two doses of ticagrelor in both male and female patients. Plasma levels of ticagrelor were significantly lower using the reduced dose of ticagrelor as compared with the standard dose in both males (pre-dose: LSM difference60 vs. 90 -212, 95%CI -391 to -33.0, p 0.002; post-dose: LSM difference60 vs. 90 -308, 95%CI -510 to -105, p =0.004) and females (pre-dose: LSM difference60 vs. 90 -131, 95%CI -332 to 69.1, p =0.19; post-dose: LSM difference60 vs. 90 -670, 95%CI -898 to -442, p 0.001). Conclusions Ticagrelor 60 mg and ticagrelor 90 twice daily yielded the same magnitude of platelet inhibition among elderly patients with ACS irrespective of sex.
Laino et al. (Sun,) reported a other. Ticagrelor 60 mg and 90 mg twice daily yielded comparable platelet inhibition in both male and female elderly patients with acute coronary syndrome (p for interaction=0.88).