DTB questions first-line use of Effient (prasugrel) | PJ Online

Clinicians cannot ignore the £1.59 daily price difference between prasugrel and clopidogrel when treating patients with acute coronary syndrome, says an editorial in the Drug and Therapeutics Bulletin.

Its November issue advises health professionals to take a pragmatic view based on price as well as factors of safety and effectiveness.

In October 2009, the National Institute for Health and Clinical Excellence recommended prasugrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention. It said the new drug was a better option than clopidogrel in, for example, patients with ST-segment-elevation myocardial infarction or diabetes mellitus. This recommendation was based on evidence from one trial comparing it with clopidogrel.

Evidence of cost-effectiveness was based on the 2009 price for prasugrel (£1.70 daily) and clopidogrel (£1.26 daily).But last month the price of generic clopidogrel fell by 90 per cent (to around 11p daily).

The trial showed that, compared with clopidogrel, prasugrel reduced the rate of death from cardiovascular causes, non-fatal myocardial infarction or non-fatal stroke; (number needed to treat of 45) but also increased the rate of major bleeding events (number needed to harm of 167).

NICE said: “There was considerable uncertainty about whether prasugrel was clinically superior to clopidogrel in terms of net clinical benefit for the licensed or the target population.”

This, together with the fact that prasugrel is a black triangle drug, should make clinicians think carefully before they follow NICE’s current recommendation to use the drug in preference to clopidogrel for some patients.

The editors say that they “seriously doubt that first-line use of prasugrel represents a good use of NHS resources”.

via pjonline.com

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