Comparative effectiveness and safety of antiplatelet drugs in patients with diabetes mellitus and acute coronary syndrome. Issue 12 (31st October 2018)

• Record Type: Journal Article
• Authors: Spoendlin, Julia; Gagne, Joshua J.; Lewey, Jennifer J.; Patorno, Elisabetta; Schneeweiss, Sebastian; Desai, Rishi J.
• Is Part Of: Pharmacoepidemiology and drug safety. Volume 27:Issue 12(2018)
• Page Start: 1361
• Page End: 1370
• Publication Date: 2018-10-31
• Subjects: clopidogrel -- diabetes -- pharmacoepidemiology -- prasugrel -- ticagrelor; Pharmacoepidemiology -- Periodicals; Chemotherapy -- Periodicals; Epidemiology -- Periodicals; 615.705
• DOI: 10.1002/pds.4668
• Languages: English
• ISSNs: 1053-8569

Abstract

Abstract: Purpose: Comparative outcomes of treatment with antiplatelet drugs in patients with acute coronary syndrome (ACS) and co‐morbid diabetes mellitus (DM) are not well studied. Methods: We performed a cohort study using US commercial claims data (2009‐2015) and conducted the following pairwise comparisons in ACS patients with DM: prasugrel vs clopidogrel, ticagrelor vs clopidogrel, and prasugrel vs ticagrelor. Outcomes of interest included (1) a composite effectiveness endpoint including myocardial infarction, ischemic stroke, or inpatient mortality; (2) a composite safety endpoint including major bleeding events requiring hospitalization; and (3) pneumonia hospitalizations as a negative control endpoint. We used calendar time‐specific propensity score matching to account for confounding and applied Cox proportional hazard models to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results: Comparative risk of the effectiveness endpoint was lower among prasugrel initiators compared to clopidogrel initiators (HR 0.82, 95% CI 0.68‐0.99, N = 7011 matched pairs), but no different between ticagrelor and clopidogrel (HR 1.02, 95% CI 0.76‐1.37, N = 3013 pairs) or prasugrel and ticagrelor (HR 0.83, 95% CI 0.58‐1.18, N = 2207 pairs). Bleeding risk was higher among prasugrel initiators when compared to clopidogrel initiators within the first month of treatment (HR 1.85, 95% CI 1.03‐3.35); no other comparison indicated any difference. No differences in the negative control outcomes were noted after PS matching for all comparisons, indicating adequate confounding control. Conclusions: Prasugrel was associated with superior cardiovascular outcomes and a higher risk of short‐term bleeding compared to clopidogrel in patients with ACS and DM. Comparative outcomes were similar between ticagrelor and clopidogrel or prasugrel and ticagrelor.