open access

Vol 14, No 5 (2019)
Review Papers
Published online: 2019-10-08
Get Citation

ISAR-REACT 5: should this trial change clinical practice?

Małgorzata Ostrowska, Piotr Adamski, Jacek Kubica
DOI: 10.5603/FC.a2019.0099
·
Folia Cardiologica 2019;14(5):483-487.

open access

Vol 14, No 5 (2019)
Review Papers
Published online: 2019-10-08

Abstract

Prasugrel and ticagrelor are oral P2Y12 receptor inhibitors indicated by the European Society of Cardiology as the preferred antiplatelet therapy in patients with acute coronary syndromes (ACS). Despite the long-term and widespread presence of these agents in clinical practice, until now they have never been directly compared in a large, randomised clinical trial. ISAR-REACT 5 was the first such study, and it has reported the superiority of prasugrel over ticagrelor. However, due to the questionable methodology of both the planning and the execution of this study, its results should be interpreted with caution, and they should not be considered sufficient to justify any changes to the current treatment strategies for patients with ACS.

Abstract

Prasugrel and ticagrelor are oral P2Y12 receptor inhibitors indicated by the European Society of Cardiology as the preferred antiplatelet therapy in patients with acute coronary syndromes (ACS). Despite the long-term and widespread presence of these agents in clinical practice, until now they have never been directly compared in a large, randomised clinical trial. ISAR-REACT 5 was the first such study, and it has reported the superiority of prasugrel over ticagrelor. However, due to the questionable methodology of both the planning and the execution of this study, its results should be interpreted with caution, and they should not be considered sufficient to justify any changes to the current treatment strategies for patients with ACS.

Get Citation

Keywords

acute coronary syndromes, antiplatelet therapy, prasugrel, ticagrelor

About this article
Title

ISAR-REACT 5: should this trial change clinical practice?

Journal

Folia Cardiologica

Issue

Vol 14, No 5 (2019)

Pages

483-487

Published online

2019-10-08

DOI

10.5603/FC.a2019.0099

Bibliographic record

Folia Cardiologica 2019;14(5):483-487.

Keywords

acute coronary syndromes
antiplatelet therapy
prasugrel
ticagrelor

Authors

Małgorzata Ostrowska
Piotr Adamski
Jacek Kubica

References (17)
  1. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018; 40(2): 87–165.
  2. Ibanez B, James S, Agewall S, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2): 119–177.
  3. Roffi M, Patrono C, Collet JP, et al. ESC Scientific Document Group. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37(3): 267–315.
  4. Wallentin L, Becker R, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009; 361(11): 1045–1057.
  5. Wiviott SD, Braunwald E, McCabe C, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007; 357(20): 2001–2015.
  6. Welsh RC, Sidhu RS, Cairns JA, et al. Outcomes among clopidogrel, prasugrel, and ticagrelor in ST-elevation myocardial infarction patients who underwent primary percutaneous coronary intervention from the TOTAL Trial. Can J Cardiol. 2019 [Epub ahead of print].
  7. Dawwas GK, Dietrich E, Winchester DE, et al. Comparative effectiveness and safety of ticagrelor versus prasugrel in patients with acute coronary syndrome: a retrospective cohort analysis. Pharmacotherapy. 2019; 39(9): 912–920.
  8. Krishnamurthy A, Keeble C, Anderson M, et al. Real-world comparison of clopidogrel, prasugrel and ticagrelor in patients undergoing primary percutaneous coronary intervention. Open Heart. 2019; 6(1): e000951.
  9. Yun JiE, Kim YJ, Park JiJ, et al. Safety and effectiveness of contemporary P2Y Inhibitors in an East Asian population with acute coronary syndrome: a nationwide population-based cohort study. J Am Heart Assoc. 2019; 8(14): e012078.
  10. De Filippo O, Cortese M, D Ascenzo F, et al. Real-world data of prasugrel vs. ticagrelor in acute myocardial infarction: results from the RENAMI Registry. Am J Cardiovasc Drugs. 2019; 19(4): 381–391.
  11. Khan MS, Memon MM, Usman MS, et al. Prasugrel vs. ticagrelor for acute coronary syndrome patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Am J Cardiovasc Drugs. 2019 [Epub ahead of print].
  12. Motovska Z, Hlinomaz O, Kala P, et al. PRAGUE-18 Study Group. 1-year outcomes of patients undergoing primary angioplasty for myocardial infarction treated with prasugrel versus tcagrelor. J Am Coll Cardiol. 2018; 71(4): 371–381.
  13. Dimitroulis D, Golabkesh M, Naguib D, et al. Safety and efficacy in prasugrel- versus ticagrelor-treated patients with ST-elevation myocardial infarction. J Cardiovasc Pharmacol. 2018; 72(4): 186–190.
  14. Bundhun PK, Shi JX, Huang F. Head to head comparison of prasugrel versus ticagrelor in patients with acute coronary syndrome: a systematic review and meta-analysis of randomized trials. BMC Pharmacol Toxicol. 2017; 18(1): 80.
  15. Schulz S, Angiolillo DJ, Antoniucci D, et al. Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 Trial Investigators. Randomized comparison of ticagrelor versus prasugrel in patients with acute coronary syndrome and planned invasive strategy--design and rationale of the iNtracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial. J Cardiovasc Transl Res. 2014; 7(1): 91–100.
  16. Schüpke S, Neumann FJ, Menichelli M, et al. ISAR-REACT 5 Trial Investigators. Ticagrelor or prasugrel in patients with acute coronary syndromes. N Engl J Med. 2019 [Epub ahead of print].
  17. Kubica J, Jaguszewski M. ISAR-REACT 5 — what have we learned? Cardiol J. 2019; 26(5): 427–428.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl