Update on the clinical development of cangrelor

Abstract

Antiplatelet drugs represent the cornerstone of treatment for cardiovascular atherothrombotic disease. Dual oral antiplatelet therapy with aspirin and oral ADP-receptor antagonists, such as clopidogrel, has been the standard choice for prevention of ischemic events in patients with acute coronary syndrome and in those undergoing percutaneous coronary intervention. However, due to the limitations of clopidogrel, such as interindividual-response variability, drug–drug interactions, slow onset of action and irreversible inhibitory effects, novel antiplatelet agents are under clinical development. Cangrelor is a reversible, potent, competitive inhibitor of the ADP P2Y₁₂ receptor that is administered intravenously and rapidly achieves near complete inhibition of ADP-induced platelet aggregation. These pharmacological properties make cangrelor a promising drug for clinical use. However, recent large-scale Phase III clinical investigations failed to show significant clinical benefit on the primary end point with cangrelor. This article provides an overview of the current status of knowledge on cangrelor, focusing on its pharmacologic properties and clinical development.

Keywords::

• acute coronary syndrome
• antiplatelet therapy
• cangrelor
• P2Y₁₂-receptor antagonist
• platelet

Financial & competing interests disclosure

Dominick J Angiolillo has received the following fees/grants from the following institutions: Honoraria/lectures: Bristol Myers Squibb; Sanofi-Aventis; Eli Lilly and Company; Daiichi Sankyo, Inc. Honoraria/advisory board: Bristol Myers Squibb; Sanofi-Aventis; Eli Lilly and Company; Daiichi Sankyo, Inc.; Astra Zeneca; The Medicines Company; Portola Pharmaceuticals; Novartis; Arena Pharmaceuticals. Research grants: GlaxoSmithKline; Otsuka; Accumetrics; Eli Lilly and Company; Daiichi Sankyo, Inc.; The Medicines Company; AstraZeneca; Eisai; Portola Pharmaceutical; Schering-Plough; Johnson and Johnson. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.