Pfizer’s Plavix, the second best-selling drug in the world, now has a formidable rival on the market. The more potent antiplatelet prasugrel, made by Eli Lilly & Co., was just approved by the FDA and Lilly’s shares rose 32 cents, or 1%, to $33.32. As I had written in my previous blog entry on this topic:
Prasugrel was tested against Plavix recently in a cleverly-designed and somewhat controversial trial called TRITON-TIMI 38. In this trial, prasugrel was shown to be about 3% better than Plavix in preventing the combined primary endpoint of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke in patients with a recent heart attack and scheduled catheterization. Unfortunately prasugrel also increased the risk of major and fatal bleeding in patients, especially the elderly and those with a history of stroke. In TRITON-TIMI 38, for every one major fatal heart attack prevented by prasugrel, one person died from a fatal bleeding event.
I’ll have to think very carefully before giving prasugrel to any of my patients and the comfort with which clinicians favor this new drug over Plavix in the management of heart attack patients will determine the scope of it’s initial success. Bleeding complications have always been a concern with Plavix and now even more so with prasugrel.
