Efficacy and safety of different ticagrelor regimens versus clopidogrel in patients with coronary artery disease: a retrospective multicenter study (SUPERIOR)

Abstract

Current guidelines favor dual anti-platelet therapy with ticagrelor 90 mg BID (T90BID) over clopidogrel 75 mg QD (C75QD) in addition to aspirin for acute coronary syndrome. However, an increased risk of ticagrelor-related adverse events prompted the evaluation of low-dose regimens. This study (NCT03381742) retrospectively analyzed the data from 11 hospitals on 3,043 patients with coronary artery disease, who received C75QD, T90BID, ticagrelor 45 mg BID (T45BID), or ticagrelor 90 mg QD (T90QD). Compared with C75QD, both T45BID and T90QD showed significantly higher inhibition of platelet aggregation (P < .0001) and lower platelet-fibrin clot strength (P < .0001) induced by adenosine diphosphate. Furthermore, compared with T90BID, two low-dose regimens had a much lower minor bleeding rate and a significantly higher proportion of patients within the therapeutic window for P2Y₁₂ receptor reactivity. There were no significant differences between T45BID and T90QD in the trough plasma concentrations of ticagrelor and its active metabolite. Similar efficacy and safety outcomes were observed in the propensity score-matched analysis. In conclusion, the low-dose ticagrelor regimen, either T45BID or T90QD, may provide a more attractive benefit-risk profile than C75QD or T90BID.

Keywords:

• Bleeding
• clopidogrel
• inhibition of platelet aggregation
• low-dose ticagrelor

Acknowledgements

We thank all the participants in the study and the members of the survey teams in each of the 11 regional centers. A complete list is provided in the Appendix.

Disclosure of interest

The authors report no conflict of interest.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by Key Program of the National Natural Science Foundation of China [81830012], General Program of the National Natural Science Foundation of China [81670297], Youth Program of the National Natural Science Foundation of China [81900374],  National Key Research and Development Program of China [2017YFC1307400], Scientific Research Project of Health and Family Planning Commission of Heilongjiang Province [2018071] and CS Optimizing Antithrombotic Research Fund [BJUHFCSOARF201801-09].