New study favours prasugrel vs ticagrelor for patients with diabetes, multivessel disease

In the treatment of patients with diabetes and multivessel disease undergoing percutaneous coronary intervention (PCI), clinical outcomes appear to be better with prasugrel than ticagrelor, according to the TUXEDO-2* study.

TUXEDO-2 was a two-by-two factorial open-label clinical trial. Researchers enrolled patients with diabetes and multivessel disease undergoing PCI at 66 clinical sites. These patients were randomly assigned to receive either ticagrelor or prasugrel, each in combination with low-dose aspirin.

The noninferiority of ticagrelor was tested against prasugrel in terms of the primary outcome of the 1-year composite of death, nonfatal myocardial infarction, stroke, or major bleeding (defined according to the Bleeding Academic Research Consortium).

A total of 1,800 patients (mean age 60 years, 72 percent male, 24.2 percent on insulin therapy, 85 percent had triple-vessel disease) were included in the analysis. At 1 year, the primary endpoint occurred in 129 participants (16.6 percent) on ticagrelor and 107 participants (14.2 percent) on prasugrel (p=0.12). The difference of 2.33 percentage points (95 percent confidence interval, −2.07 to 6.74) did not meet the prespecified threshold for noninferiority (p=0.84).

Compared with prasugrel, ticagrelor was associated with numerically higher incidence of a composite of death, myocardial infarction, or stroke (10.43 percent vs 8.63 percent; p=0.30), as well as major bleeding (8.41 percent vs 7.14 percent; p=0.19).

*The Ultrathin Strut vs Xience in a Diabetic Population With Multivessel Disease 2—India Study